Postoperative Radiation With or Without Concurrent Chemotherapy for Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma With Multiple Intermediate Risks: A Propensity Score-Matched Study.

Publisher: John Wiley & Sons Ltd Country of Publication: United States NLM ID: 101595310 Publication Model: Print Cited Medium: Internet ISSN: 2045-7634 (Electronic) Linking ISSN: 20457634 NLM ISO Abbreviation: Cancer Med Subsets: MEDLINE

Original Publication: [Malden, MA] : John Wiley & Sons Ltd., c2012-

Squamous Cell Carcinoma of Head and Neck*/therapy ; Squamous Cell Carcinoma of Head and Neck*/pathology ; Squamous Cell Carcinoma of Head and Neck*/mortality ; Head and Neck Neoplasms*/therapy ; Head and Neck Neoplasms*/pathology ; Head and Neck Neoplasms*/mortality ; Chemoradiotherapy*; Humans ; Male ; Female ; Middle Aged ; Propensity Score ; Aged ; Retrospective Studies ; Risk Factors ; Adult ; Neoplasm Staging

Background: The benefit of postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone remains unclear for resected locally advanced head and neck squamous cell carcinoma (LA-HNSCC) patients with intermediate risk(s) such as pT3 or pT4 primary, pN2 or pN3 nodal disease, nodal disease in levels IV or V, perineural invasion (PNI), and lymphovascular invasion (LVI). This study aims to evaluate the benefits of postoperative CRT in patients with multiple intermediate risks.
Method: LA-HNSCC patients who underwent curative surgery with intermediate risk at our institution were identified. A propensity score-matched (PSM) method was performed using treatment, sex, age, AJCC staging, LVI, and PNI as covariates.
Result: A total of 162 eligible patients were identified. After PSM, 48 patients were classified into CRT and RT groups, respectively. Baseline characteristics and treatment were well balanced. In the CRT group, most patients received cisplatin-CRT (67%). Patients with 1, 2, and ≥ 3 intermediate risk factors exhibited significantly different event-free survival (EFS) (7.2 vs. 3.8 vs. 1.9 years; p = 0.007), with a trend towards differences in overall survival (OS) (p = 0.068). The median OS of the postoperative RT and CRT groups was not significantly different (4.5 vs. 5.0 years; p = 0.950). Similarly, the median EFS was not significantly different (p = 0.634). No EFS and OS benefits were demonstrated in patients with ≥ 2 intermediate risk factors treated with CRT compared to RT alone.
Conclusion: In our PSM study, LA-HNSCC patients with intermediate risk(s) did not benefit from postoperative CRT compared to RT alone. Although patients with multiple intermediate risks had significantly worse survivals, postoperative CRT did not improve OS and EFS. The results of this study may support avoiding unnecessary acute and late toxicity associated with adding chemotherapy to postoperative RT in patients with intermediate risk(s).
(© 2025 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

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63-140 Health Systems Research Institute; B05F650041 National Science Research Fund (NSRF) via the Program Management Unit for Human Resources & Institutional Development, Research and Innovation; Government Research Grant #3484 (Project #6908) Mahidol University; National Research Council of Thailand

Keywords: CRT; HNSCC; adjuvant; chemoradiotherapy; head and neck squamous cell carcinoma; intermediate risk; locally advanced; postoperative; radiation; radiotherapy

Date Created: 20250307 Date Completed: 20250511 Latest Revision: 20250511

20250512

PMC11886883

10.1002/cam4.70746

40052649