Is concurrent chemoradiation the treatment of choice for all patients with Stage III or IV head and neck carcinoma?

Background: Many patients with small primary tumors of the oropharynx have AJCC Stage III/IV disease on the basis of lymphadenopathy. In the current retrospective study, the authors hypothesized that these patients have high rates of locoregional control when treated with radiotherapy, either alone or combined with neck surgery, and may not require concurrent chemotherapy.

Methods: Two hundred ninety-nine patients met staging and inclusion criteria. Stage distribution was as follows: T1, 99 patients (33%); T2, 182 patients (61%); Tx, 18 patients (6%); N1, 74 patients (25%); N2, 170 patients (57%); N3, 39 patients (13%); and Nx, 16 patients (5%). Primary tumor resection or tonsillectomy had been performed in 36 patients (12%) and excisional lymph node biopsy or formal neck dissection in 192 patients (64%). Thirty-three additional patients (10%) received chemotherapy and were analyzed separately.

Results: The median follow-up was 82 months (range, 8-299 months). The actuarial 5-year rates of locoregional failure, distant metastases, and overall survival were 15%, 19%, and 64%, respectively. T status was associated with the 5-year rate of locoregional control: 95% for patients with T1-/Tx disease, compared with 79% for patients with T2 disease (P < 0.01). The 5-year rate of distant metastases for patients with N1/2a disease was 11%, compared with 28% for patients with N2b/N2c/N3 disease (P < 0.001).

Conclusions: Patients with early-T status oropharyngeal carcinoma, which is considered advanced due to the presence of lymphadenopathy, have high rates of locoregional control when treated with radiotherapy without or with neck surgery. Local treatment intensification by the addition of concurrent chemotherapy to radiotherapy would not significantly benefit most of these patients.