Increased rate of recurrence and high rate of salvage in patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma with adverse features treated with primary surgery without recommended adjuvant therapy

Head Neck. 2021 Apr;43(4):1128-1141. doi: 10.1002/hed.26578. Epub 2020 Dec 16.


Background: Some patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) do not receive guideline-recommended postoperative radiation therapy (PORT) following primary transoral robotic surgery (TORS).

Methods: Three-hundred and sixty-four patients with treatment-naïve, HPV-associated OPSCC were recommended to receive PORT based on clinicopathological features following TORS. Patients were stratified based on if they received PORT. Oncologic outcomes were compared.

Results: The 3-year locoregional failure (LRF) was 32% in patients who did not receive PORT and 4% in patients who received PORT (P < .001). Despite increased LRF, avoiding PORT was not associated with increased 3-year distant metastasis rates (8% vs 4%, P = .56) or worse 3-year survival (95% vs 98%, P = .34). Recurrences in the surgery alone cohort varied between local and regional sites and were often successfully salvaged.

Conclusions: Patients with HPV-associated OPSCC who do not receive indicated PORT have an increased risk of LRF but similar survival due to high salvage rates.

Keywords: TORS; adjuvant therapy; head and neck cancer; oropharyngeal cancer; overall survival; radiation therapy; recurrence.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Alphapapillomavirus*
  • Carcinoma, Squamous Cell* / therapy
  • Head and Neck Neoplasms*
  • Humans
  • Neoplasm Recurrence, Local
  • Oropharyngeal Neoplasms* / surgery
  • Papillomaviridae
  • Retrospective Studies
  • Robotic Surgical Procedures* / adverse effects
  • Squamous Cell Carcinoma of Head and Neck / surgery