Clinical and translational radiation oncology · 2026
Survival outcomes of radiotherapy alone versus concurrent chemoradiotherapy in T1-2 head and neck cancer with low-volume disease: A multicenter cohort study.
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Zhang Chuanhao, Cheng Zhichao, Jiang Xin, Zhao Genghao, Zhu Yanmei, Hou Bowen, Sun Yingming, Liang Shanshan, Zhang Ye, Wang Ruoyu, Wang Zhe
Аннотация
BACKGROUND: The optimal treatment strategy between definitive radiotherapy and concurrent chemoradiotherapy (CCRT) for patients with T1-2 head and neck cancer with low-volume nodal disease remains unclear due to limited supporting data. This study aimed to compare overall survival (OS) and progression-free survival (PFS) between the two treatment modalities.
METHODS: Patients with AJCC 7th edition stage T1-2N1-2a head and neck squamous cell carcinoma (HNSCC) were collected from multiple research centers, including the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (NCC), the University Health Network (UHN), and Quebec, Canada. Inverse probability of treatment weighting (IPTW) was applied to balance baseline differences. Kaplan-Meier analysis and Cox proportional hazards models were used to compare OS and PFS between the two groups.
RESULTS: A total of 240 patients were included, with a median age of 57.8 years (IQR 52.0-65.1); 51 patients (21%) were HPV-negative. After IPTW adjustment, multivariable Cox analysis showed that CCRT did not provide a significant OS benefit compared with radiotherapy alone (hazard ratio [HR], 0.50; 95% CI, 0.20-1.24; P = 0.14). However, CCRT was associated with a significant improvement in PFS (HR, 0.42; 95% CI, 0.19-0.93; P = 0.03). Consistent with the NRG-HN002 trial, which showed a 9.7% absolute reduction in locoregional failure with CCRT relative to radiotherapy alone.
CONCLUSIONS: This multicenter study demonstrated that while CCRT conferred limited OS benefit in patients with stage T1-2N1-2a HNSCC, it improved tumor progression control in a subset of patients. Careful evaluation of survival benefit versus treatment-related toxicity is warranted, and larger prospective studies are needed to validate these findings.
METHODS: Patients with AJCC 7th edition stage T1-2N1-2a head and neck squamous cell carcinoma (HNSCC) were collected from multiple research centers, including the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (NCC), the University Health Network (UHN), and Quebec, Canada. Inverse probability of treatment weighting (IPTW) was applied to balance baseline differences. Kaplan-Meier analysis and Cox proportional hazards models were used to compare OS and PFS between the two groups.
RESULTS: A total of 240 patients were included, with a median age of 57.8 years (IQR 52.0-65.1); 51 patients (21%) were HPV-negative. After IPTW adjustment, multivariable Cox analysis showed that CCRT did not provide a significant OS benefit compared with radiotherapy alone (hazard ratio [HR], 0.50; 95% CI, 0.20-1.24; P = 0.14). However, CCRT was associated with a significant improvement in PFS (HR, 0.42; 95% CI, 0.19-0.93; P = 0.03). Consistent with the NRG-HN002 trial, which showed a 9.7% absolute reduction in locoregional failure with CCRT relative to radiotherapy alone.
CONCLUSIONS: This multicenter study demonstrated that while CCRT conferred limited OS benefit in patients with stage T1-2N1-2a HNSCC, it improved tumor progression control in a subset of patients. Careful evaluation of survival benefit versus treatment-related toxicity is warranted, and larger prospective studies are needed to validate these findings.