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ccr-23-3247_supplementary_table_s2_suppts2.pdf (146.08 kB)

Supplementary Table S2 from Upfront Neck Dissection for Treatment Selection and Improvement in Quality of Life as a Novel Treatment Paradigm for Deintensification in HPV+ OPSCC

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posted on 2024-06-03, 07:20 authored by Paul L. Swiecicki, Emily Bellile, Aleksandar F. Dragovic, Jonathan McHugh, Aaron Udager, Michelle Lynn Mierzwa, Jennifer Shah, Molly Heft-Neal, Andrew Rosko, Kelly M. Malloy, Keith Casper, Steven Bennett Chinn, Andrew G. Shuman, Chaz Stucken, Douglas B. Chepeha, Gregory T. Wolf, Carol Rossier Bradford, Avraham Eisbruch, Mark E. Prince, Francis P. Worden, Matthew E. Spector

Supplementary Table 2: Change in Stage with Neck Dissection

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National Cancer Institute (NCI)

United States Department of Health and Human Services

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ARTICLE ABSTRACT

Locoregionally advanced HPV+ oropharyngeal squamous cell carcinoma (OPSCC) has excellent cure rates, although current treatment regimens are accompanied by acute and long-term toxicities. We designed a phase II deescalation trial for patients with HPV+ OPSCC to evaluate the feasibility of an upfront neck dissection to individualize definitive treatment selection to improve the quality of life without compromising survival. Patients with T1–3, N0–2 HPV+ OPSCC underwent an upfront neck dissection with primary tumor biopsy. Arm A included patients with a single lymph node less than six centimeters, with no extracapsular spread (ECS) and no primary site adverse features underwent transoral surgery. Arm B included patients who had two or more positive lymph nodes with no ECS, or those with primary site adverse features were treated with radiation alone. Arm C included patients who had ECS in any lymph node and were treated with chemoradiation. The primary endpoint was quality of life at 1 year compared with a matched historical control. Thirty-four patients were enrolled and underwent selective neck dissection. On the basis of pathologic characteristics, 14 patients were assigned to arm A, 10 patients to arm B, and 9 to arm C. A significant improvement was observed in Head and Neck Quality of Life (HNQOL) compared with historical controls (−2.6 vs. −11.9, P = 0.034). With a median follow-up of 37 months, the 3-year overall survival was 100% and estimated 3-year estimated progression-free survival was 96% [95% confidence interval (CI), 76%–99%]. A neck dissection–driven treatment paradigm warrants further research as a deintensification strategy.

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