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Chemoradiation Therapy Versus Radiation Therapy Alone in T1-2 Oropharyngeal Cancer With Low-Volume Neck Disease: A Population-Based Cohort Study Using the Swedish Head and Neck Cancer Register

Adrian, Gabriel LU orcid ; Rudolfson Falklind, Niclas LU ; McDowell, Lachlan and Gebre-Medhin, Maria LU (2026) In International Journal of Radiation Oncology Biology Physics 124(2). p.340-348
Abstract
Purpose
The benefit of adding concurrent systemic therapy to definitive radiation therapy (RT) for patients with T1-2 oropharyngeal squamous cell carcinoma (OPSCC) and limited neck node involvement is uncertain. This study investigates whether chemotherapy (CRT) in patients with early-stage (T1-2) low-volume nodal disease (Union for International Cancer Control Seventh Edition N1-2b) improves overall survival (OS) compared with RT alone.
Methods and Materials
A cohort study of data from the prospective Swedish Head and Neck Cancer Register leveraged variation in receiving CRT based on the health care region. Propensity score matching (1:1) was applied to balance baseline characteristics between patients from regions favoring... (More)
Purpose
The benefit of adding concurrent systemic therapy to definitive radiation therapy (RT) for patients with T1-2 oropharyngeal squamous cell carcinoma (OPSCC) and limited neck node involvement is uncertain. This study investigates whether chemotherapy (CRT) in patients with early-stage (T1-2) low-volume nodal disease (Union for International Cancer Control Seventh Edition N1-2b) improves overall survival (OS) compared with RT alone.
Methods and Materials
A cohort study of data from the prospective Swedish Head and Neck Cancer Register leveraged variation in receiving CRT based on the health care region. Propensity score matching (1:1) was applied to balance baseline characteristics between patients from regions favoring CRT and those receiving RT alone. OS and loco-regional control (LRC) were compared between groups using Kaplan-Meier analyses and Cox regression models. Separate matching and analyses were conducted for patients with T1-2N1-2a (cohort N1-2a, ie, single node < 6 cm) and T1-2N2b disease (cohort N2b, ie, multiple nodes < 6 cm).
Results
A total of 1507 patients with T1-2N1-2b OPSCC were included. After propensity score matching, cohort N1-2a consisted of 262 patients and cohort N2b of 692 patients.
OS was similar between CRT and RT alone in both cohorts, with a hazard ratio (HR) of 1.57 (95% CI, 0.68-3.87; p = .17) for cohort N1-2a, and an HR of 0.95 (95% CI, 0.66-1.35; p = .77) for cohort N2b. LRC was also similar between CRT and RT in cohort N1-2a (HR, 0.98 [95% CI, 0.34-2.78]; p = .98). In cohort N2b, a statistical interaction (p < .001) was found with age, with a benefit of CRT for patients aged ≤70 years (HR, 0.30 [95% CI, 0.16-0.58]), but not for patients aged >70 years (HR, 1.48 [95% CI, 0.50-4.39]). The difference in LRC was driven by failures at the primary tumor site. Exploratory analyses suggested a selective benefit of CRT for patients with T2N2b.
Conclusions
The results of this large, robust, national register suggest that RT alone is a safe treatment option for patients with T1-2N1-2a OPSCC. In patients with multiple neck nodes (N2b) aged ≤70 years, CRT improved LRC but not overall survival. (Less)
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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International Journal of Radiation Oncology Biology Physics
volume
124
issue
2
pages
340 - 348
publisher
Elsevier
external identifiers
  • pmid:40848943
  • scopus:105016397511
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2025.08.040
language
English
LU publication?
yes
id
155048ce-6571-482a-876f-0e6b148da287
date added to LUP
2025-11-11 01:24:20
date last changed
2026-06-10 09:11:27
@article{155048ce-6571-482a-876f-0e6b148da287,
  abstract     = {{Purpose<br/>The benefit of adding concurrent systemic therapy to definitive radiation therapy (RT) for patients with T1-2 oropharyngeal squamous cell carcinoma (OPSCC) and limited neck node involvement is uncertain. This study investigates whether chemotherapy (CRT) in patients with early-stage (T1-2) low-volume nodal disease (Union for International Cancer Control Seventh Edition N1-2b) improves overall survival (OS) compared with RT alone.<br/>Methods and Materials<br/>A cohort study of data from the prospective Swedish Head and Neck Cancer Register leveraged variation in receiving CRT based on the health care region. Propensity score matching (1:1) was applied to balance baseline characteristics between patients from regions favoring CRT and those receiving RT alone. OS and loco-regional control (LRC) were compared between groups using Kaplan-Meier analyses and Cox regression models. Separate matching and analyses were conducted for patients with T1-2N1-2a (cohort N1-2a, ie, single node &lt; 6 cm) and T1-2N2b disease (cohort N2b, ie, multiple nodes &lt; 6 cm).<br/>Results<br/>A total of 1507 patients with T1-2N1-2b OPSCC were included. After propensity score matching, cohort N1-2a consisted of 262 patients and cohort N2b of 692 patients.<br/>OS was similar between CRT and RT alone in both cohorts, with a hazard ratio (HR) of 1.57 (95% CI, 0.68-3.87; p = .17) for cohort N1-2a, and an HR of 0.95 (95% CI, 0.66-1.35; p = .77) for cohort N2b. LRC was also similar between CRT and RT in cohort N1-2a (HR, 0.98 [95% CI, 0.34-2.78]; p = .98). In cohort N2b, a statistical interaction (p &lt; .001) was found with age, with a benefit of CRT for patients aged ≤70 years (HR, 0.30 [95% CI, 0.16-0.58]), but not for patients aged &gt;70 years (HR, 1.48 [95% CI, 0.50-4.39]). The difference in LRC was driven by failures at the primary tumor site. Exploratory analyses suggested a selective benefit of CRT for patients with T2N2b.<br/>Conclusions<br/>The results of this large, robust, national register suggest that RT alone is a safe treatment option for patients with T1-2N1-2a OPSCC. In patients with multiple neck nodes (N2b) aged ≤70 years, CRT improved LRC but not overall survival.}},
  author       = {{Adrian, Gabriel and Rudolfson Falklind, Niclas and McDowell, Lachlan and Gebre-Medhin, Maria}},
  issn         = {{0360-3016}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{340--348}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Radiation Oncology Biology Physics}},
  title        = {{Chemoradiation Therapy Versus Radiation Therapy Alone in T1-2 Oropharyngeal Cancer With Low-Volume Neck Disease: A Population-Based Cohort Study Using the Swedish Head and Neck Cancer Register}},
  url          = {{http://dx.doi.org/10.1016/j.ijrobp.2025.08.040}},
  doi          = {{10.1016/j.ijrobp.2025.08.040}},
  volume       = {{124}},
  year         = {{2026}},
}