Down for the count.

Top Line: Number of involved nodes is now included in the staging of HPV(+) head and neck (H&N) cancers, but it’s not made it to guidelines as a factor to influence the decision for post-op chemoradiation.
The Study: More and more data is demonstrating a clear association between the absolute number of nodes involved with non-oropharyngeal H&N cancer and survival outcomes. Most recently, another NCDB analysis asks if a survival benefit from the addition of concurrent chemo to post-op radiation can be discerned from the number of nodes involved, in addition to the traditional criteria of positive margins and extracapsular extension. Well, it did more than that. Beyond confirming a significant association with worse survival overall, pathologic nodal involvement was associated with a significant survival benefit with chemoradiation when more than 2 (HR 0.84), and even more so when more than 5 (HR 0.65), nodes were involved. What factors failed to predict a survival advantage with the addition of chemo to post-op radiation? Positive margins and extracapsular extension.
TBL: Increasing number of pathologic nodes involved should give you increasing pause to consider the addition of chemo to post-op radiation for non-oropharyngeal H&N cancer. | Zumsteg, Ann Oncol 2019


  1. very hard to trust registry data analyses when the conclusion directly contradict level 1 evidence

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