Single and not ready to mingle with chemo.

Top Line: The current standard of care for resected head and neck (H&N) cancer found to have pathologic nodal extracapsular extension (ECE) is a ticket for adjuvant chemoradiation.

The Study: What comes with sweeping staging changes, though? Sweeping confusion over what degree of therapy is indicated when. The recommendation for post-op combined chemoradiation is based on lumping all ECE together as a risk factor in RTOG 9501 and EORTC 22931. But, as with most things, ECE falls on a spectrum. In the new staging system for HPV- disease, ECE automatically makes for at least pN2a disease, even if only one node is involved—remember, ECE alternatively has no bearing whatsoever on staging for HPV+ disease. This very specific NCDB analysis looks at outcomes for patients with precisely this: pN2a (single involved node < 3 cm with ECE) HPV- H&N cancer following a margin-negative resection. Among 504 patients fitting this bill between 2004-2015, 59% received adjuvant chemoradiation and the remaining 41% adjuvant radiation alone. On multivariate analysis, the hazard for death was virtually identical for each cohort, which held true regardless of tumor stage.

TBL: Retrospective data indicates patients with only a single node involved with HPV- H&N cancer, even with pathologic ECE (i.e., pN2a disease) but with no other risk factors, do not benefit from the addition of chemotherapy to adjuvant radiation. | Ba, JAMA Otolaryngol Head Neck Surg 2020