Top Line: Definitive radiation to 70 Gy with concurrent cisplatin remains the tried and true standard treatment for locally-advanced HPV+ oropharyngeal squamous cell carcinoma (SCC).
The Study: The latest de-escalation approach is looking to deliver 0 Gy. Neoadjuvant chemotherapy followed by definitive transoral robotic surgery–cleverly referred to as NECTORS–consists of 3 cycles of docetaxel+cisplatin prior to TORS with no planned radiation. This retrospective analysis compared a prospectively captured cohort of 110 patients receiving NECTORS with a contemporaneous cohort of 232 patients receiving standard chemoradiation. They all had old-school stage III-IVA disease meaning cT3-4 and/or cN+, and no patient received adjuvant radiation following NECTORS. With a median follow-up over 5 years, locoregional recurrence was 4.5-4.7% either way. However, the authors focus on a large discrepancy in distant mets which occurred in 33 (14%) of patients after chemoradiation versus 1 (1%) after NECTORS. What’s more, overall survival was 80% at 5 years out from chemoradiation versus 100% after NECTORS, which the authors feel was driven by distant metastases. The obvious elephant in the room? Comparing a narrowly selected group of patients eligible for NECTORS to an unselected group.
TBL: Enthusiastic proponents of NECTORS are energized by this apples to oranges comparison, though any change in practice away from the decades-long standard of chemoradiation should await a prospective randomized trial. | Sadeghi, JAMA Otolaryngol Head Neck Surg 2024
The Study: The latest de-escalation approach is looking to deliver 0 Gy. Neoadjuvant chemotherapy followed by definitive transoral robotic surgery–cleverly referred to as NECTORS–consists of 3 cycles of docetaxel+cisplatin prior to TORS with no planned radiation. This retrospective analysis compared a prospectively captured cohort of 110 patients receiving NECTORS with a contemporaneous cohort of 232 patients receiving standard chemoradiation. They all had old-school stage III-IVA disease meaning cT3-4 and/or cN+, and no patient received adjuvant radiation following NECTORS. With a median follow-up over 5 years, locoregional recurrence was 4.5-4.7% either way. However, the authors focus on a large discrepancy in distant mets which occurred in 33 (14%) of patients after chemoradiation versus 1 (1%) after NECTORS. What’s more, overall survival was 80% at 5 years out from chemoradiation versus 100% after NECTORS, which the authors feel was driven by distant metastases. The obvious elephant in the room? Comparing a narrowly selected group of patients eligible for NECTORS to an unselected group.
TBL: Enthusiastic proponents of NECTORS are energized by this apples to oranges comparison, though any change in practice away from the decades-long standard of chemoradiation should await a prospective randomized trial. | Sadeghi, JAMA Otolaryngol Head Neck Surg 2024