Long-term follow-up of neoadjuvant chemotherapy in resectable human papillomavirus-associated oropharyngeal cancer.

backgroundDe-escalation strategies have gained increasing attention for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). We previously introduced an approach using upfront neoadjuvant chemotherapy (NAC) to facilitate less invasive surgery and potentially omit postoperative radiotherapy (PORT) or chemoradiotherapy (POCRT). This study evaluated the long-term outcomes and late toxicities of NAC followed by surgery after a 5-year follow-up.

methodsWe retrospectively analyzed 41 patients with resectable HPV-positive OPSCC who received NAC followed by primary tumor resection, with or without neck dissection. Patients were treated with triplet NAC comprising either docetaxel, cisplatin, and 5-fluorouracil (TPF) or carboplatin, paclitaxel, and cetuximab.

resultsA pathological complete response (pCR) at both the primary site and lymph nodes was achieved in 25 patients (61.0%), and PORT/POCRT was required in 6 patients (14.6%). Among the 36 patients who received NAC-TPF, the number of TPF cycles administered in the pCR group was significantly higher than in the non-pCR group (p = 0.0401). The median follow-up period was 5.3 years, with 5-year overall and progression-free survival rates of 92.4% and 80.1%, respectively. Recurrence occurred in 25% of the non-pCR group and 8% of the pCR group. All patients resumed oral intake without nutritional intervention within 35 days after treatment, and no severe late toxicities impairing daily life were observed.

conclusionLong-term follow-up demonstrated that NAC followed by surgery-aimed at achieving less invasive procedures and avoiding PORT/POCRT-is feasible and promising in terms of survival and late toxicities in patients with resectable HPV-associated OPSCC.