Postoperative radiation in early stage oropharyngeal squamous cell cancer (OPSCC)
Reviewed by Sarj Vasani

There is significant variation in treatment strategies for OPSCC between units. This is largely due to unanswered questions which continue to exist beyond the published literature. We know that human papilloma virus status has a significant influence on prognosis but to what extent should it affect our treatment strategies? This question is important in early stage OPSCC where single modality treatment is desirable. This paper took a cohort of 81 surgically treated OPSCC patients who were either pT1pN1cM0 or pT2pN0cM0, all of whom had negative microscopic margins and no extracapsular extension in positive nodes. Of these patients, adjuvant radiotherapy was given to 33 patients with 48 patients having surgery alone. Only patients treated with a postoperative dose of 60Gy or less were included. Median follow-up was 47.9 months. The analysis showed that both the recurrence free survival (RFS) and overall survival (OS) in the p16 positive group did not improve with postoperative radiotherapy as almost all patients survived regardless of adjuvant treatment. On the other hand, in the p16 negative group patients had significantly longer recurrence free survival when postoperative radiotherapy was given. This applied to both pT1pN1cM0 and pT2pN0cM0 cohorts. A trend towards improved overall survival was also shown with adjuvant treatment. There are ongoing larger studies being conducted both in the US and UK to further assess the validity of these findings. This will have strong implications for choice of treatment in early OPSCC especially where single modality treatment is favoured. 

Effect of postoperative radiotherapy in pT1pN1cM0 and pT2p/cN0cM0 oropharyngeal squamous cell carcinoma.
Kadletz L, Heiduschka G, Wolf A, et al.
THE LARYNGOSCOPE
2018;128(5):1075-82.