%0 Journal Article
%T Risk of recurrence after neoadjuvant chemotherapy and transoral robotic surgery in patients with oropharynx cancer that avoid adjuvant radiation.
%A Pershad AR
%A Thakkar PG
%A Goodman JF
%A Joshi A
%A Steinberg SM
%A Allen CT
%A Floudas CS
%J Cancer Med
%V 13
%N 7
%D 2024 Apr
%M 38581118
%F 4.711
%R 10.1002/cam4.7146
%X <B>BACKGROUND: </B>De-escalation strategies for newly-diagnosed p16-positive oropharyngeal squamous cell carcinoma (p16+ OPSCC), aim to reduce treatment-related morbidity without compromising disease control. One strategy is neoadjuvant cisplatin and docetaxel chemotherapy (NAC + S) before transoral robotic surgery, with pathology-based risk-adapted adjuvant treatment.<BR><B>METHODS: </B>We examined the recurrence-free survival (RFS) for patients who received NAC + S.<BR><B>RESULTS: </B>Comparing outcomes in 103 patients between 2008 and 2023, 92% avoided adjuvant treatment and showed significantly higher 2-year recurrence-free survival (RFS) compared to those with adjuvant treatment (95.9% vs. 43.8%, p = 0.0049) CONCLUSION: Our findings suggest that pathology-based risk-adapted omission of adjuvant treatment following NAC + S does not appear to elevate recurrence risk and that NAC may identify patients with favorable tumor biology, yielding a 2-year RFS probability exceeding 95% without adjuvant treatment. Further, the study identifies a patient subset experiencing disease recurrence despite triple modality therapy. Despite limitations, including a retrospective design and modest sample size, the data advocate for controlled NAC + S studies.