Evidence map›Paper›PMID 33934525›Full record

ArticleCancer medicine2021

The addition of chemotherapy to adjuvant radiation is associated with inferior survival outcomes in intermediate-risk HPV-negative HNSCC.

Jason Tasoulas, Nicholas R Lenze, Douglas Farquhar, Travis P Schrank, Colette Shen, M Ali Shazib, Bart Singer, Shetal Patel, Juneko E Grilley Olson, David N Hayes and 6 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Cancer medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.2field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 10 citations in OpenAlex.

  1. Postoperative Lymph Is a Proximal Source of ctDNA for Detection of Recurrence in HPV-Independent Head and Neck Cancer.Clinical cancer research : an official journal of the American Association for Cancer Research · 2026
    Article
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 2 institutions in 1 country.

Jason TasoulasDepartment of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.ORCID 0000-0003-3791-3252
Nicholas R LenzeDepartment of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Douglas FarquharDepartment of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Travis P SchrankDepartment of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.ORCID 0000-0002-8297-3329
Colette ShenDepartment of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
M Ali ShazibDivision of Diagnostic Sciences, Adams School of Dentistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Bart SingerDepartment of Pathology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Shetal PatelDivision of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Juneko E Grilley OlsonDivision of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
David N HayesDivision of Hematology-Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Margaret L GulleyDepartment of Pathology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Bhishamjit S CheraDepartment of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Trevor HackmanDepartment of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Andrew F OlshanDepartment of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Jared WeissDivision of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Siddharth ShethDivision of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.ORCID 0000-0002-1923-2309
University of North Carolina at Chapel Hill · USUniversity of Tennessee Health Science Center · US

Funding

UNC-CH CENTER FOR ENVIRONMENTAL HEALTH &SUSCEPTIBILITYP30ES010126 · NIEHS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Melissa A. Troester · 2001 to 2026
$36.3M
Gene Environment Interaction in Head and Neck CancerR01CA090731 · NCI · UNIVERSITY OF NORTH CAROLINA CHAPEL HILL · PI OLSHAN, ANDREW · 2001 to 2005
$4.6M
NCI NIH HHS R01 CA090731NIEHS NIH HHS P30 ES010126
6 · The paper itself

Abstract

backgroundOnly high-risk tumors with extranodal extension (ENE) and/or positive surgical margins (PSM) benefit from adjuvant therapy (AT) with concurrent chemoradiation (CRT) compared to radiation therapy (RT) in locally advanced head and neck squamous cell carcinoma (HNSCC). Optimal treatment for intermediate-risk tumors remains controversial. We categorized patients based on their surgical pathologic risk factors and described AT treatment patterns and associated survival outcomes.

methodsPatients were identified from CHANCE, a population-based study, and risk was classified based on surgical pathology review. High-risk patients (n = 204) required ENE and/or PSM. Intermediate-risk (n = 186) patients had pathological T3/T4 disease, perineural invasion (PNI), lymphovascular invasion (LVI), or positive lymph nodes without ENE. Low-risk patients (n = 226) had none of these features.

resultsWe identified 616 HPV-negative HNSCC patients who received primary surgical resection with neck dissection. High-risk patients receiving AT had favorable OS (HR 0.50, p = 0.013) which was significantly improved with the addition of chemotherapy compared to RT alone (HR 0.47, p = 0.021). When stratified by node status, the survival benefit of AT in high-risk patients persisted only among those who were node-positive (HR: 0.17, p < 0.0005). On the contrary, intermediate-risk patients did not benefit from AT (HR: 1.26, p = 0.380) and the addition of chemotherapy was associated with significantly worse OS compared to RT (HR: 1.76, p = 0.046).

conclusionIn high-risk patients, adjuvant chemoradiotherapy improved OS compared to RT alone. The greatest benefit was in node-positive cases. In intermediate-risk patients, the addition of chemotherapy to RT increased mortality risk and therefore should only be used cautiously in these patients.

Indexed as

AgedChemoradiotherapy, AdjuvantCombined Modality TherapyFemaleHead and Neck NeoplasmsHumansLymph NodesMaleMargins of ExcisionMiddle AgedNeck DissectionNeoplasm StagingPapillomavirus InfectionsRadiotherapy, AdjuvantRetrospective StudiesSquamous Cell Carcinoma of Head and Neckadjuvant radiotherapychemotherapyhead and neck cancerhead and neck squamous cell carcinomaHPV-negativerisk factorssurvival

Identifiers

PMID33934525
PMCPMC8124130
OpenAlexW3157142057

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.