ArticleFrontiers in oncology2026
De-escalating radiotherapy in pathologic complete response oral cancer after neoadjuvant immunochemotherapy: equal survival, better life, and a biomarker guide.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The potential to omit adjuvant radiotherapy in patients with locally advanced oral squamous cell carcinoma (OSCC) who achieve a pathological complete response (pCR) after neoadjuvant immunochemotherapy (NICT) remains undefined. This study aimed to evaluate the oncologic safety of a radiotherapy-de-escalation strategy and to identify predictive biomarkers for its success. Methods: In this retrospective cohort study, pCR patients were categorized into a de-escalation group (n=65) and a standard care group (adjuvant radiotherapy/chemoradiotherapy, n=286). Propensity score matching (PSM) was performed to compare disease-free survival (DFS). Comprehensive genomic and immune profiling was conducted on pre-treatment biopsies from the de-escalation cohort to identify biomarkers associated with recurrence. Results: After 1:1 PSM, DFS was equivalent between the de-escalation and standard care groups (HR 1.25, 95% CI 0.72-2.18; p=0.425). The de-escalation strategy yielded significantly better quality of life and eliminated severe radiation toxicities, albeit with increased immune-related adverse events. Within the de-escalation cohort, multivariate analysis identified TP53 mutation (adjusted HR 4.05, p=0.019) and a low pre-treatment B cell signature score (adjusted HR 2.15 per 1-unit decrease, p=0.010) as independent predictors of worse DFS. A two-biomarker model stratified patients into low-, intermediate-, and high-risk groups with distinct recurrence rates (0%, 17.1%, and 40.0%, respectively; p=0.019). Conclusion: Adjuvant radiotherapy omission with maintenance immunotherapy appears to be a safe and patient-beneficial strategy for OSCC patients achieving pCR after NICT. The integrated TP53/B-cell biomarker model provides preliminary evidence for personalizing this de-escalation approach.
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