Dr Stokes on Radiation Vs Surgery in HPV+ OPSCC

William (Bill) Stokes, MD, assistant professor, the Department of Radiation Oncology, Emory University School of Medicine, medical oncologist, Winship Cancer Institute, discusses the use of radiation vs surgery for the treatment of patients with human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC).

Although numerous retrospective comparative analyses and studies have addressed whether an organ preservation–based approach or a surgical approach is preferred for the treatment of patients with HPV-related OPSCC, prospective randomized studies are the best way to provide definitive guidance in this space, Stokes begins. To date, there have been only 2 prospective trials evaluating this question: the phase 2 ORATOR trial (NCT01590355) and the ORATOR2 trial (NCT03210103), which were both conducted in Canada, he adds. Although these studies did have some flaws, the ORATOR trials currently stand as the highest quality of evidence for the use of radiation vs surgery in HPV-related OPSCC, Stokes emphasizes.

When looking at the disease outcomes from these studies, there was not a difference between surgery and organ preservation–based approaches, Stokes continues. In ORATOR, patients treated with radiation had a statistically significant improvement in swallowing quality of life, but the difference did not meet the prespecified threshold of clinical significance. There was no difference in progression-free survival (PFS) or overall survival (OS) between the groups. In ORATOR2, surgery was associated with an unacceptable risk of grade 5 toxicity effects, but patients in both trial arms achieved good swallowing outcomes at 1 year. Additional follow-up is ongoing to assess OS and PFS outcomes.

Given the similar outcomes noted in ORATOR, looking at the toxicity profile of each approach and the quality of life for patients could help be a determining factor for making treatment decisions for patients with OPSCC, Stokes concludes.