Adjuvant treatment in elderly patients undergoing transoral surgery for HPV-related oropharyngeal cancer.

[OBJECTIVES] Older adults are an increasing proportion of patients with HPV-related oropharyngeal squamous cell carcinoma (OPSCC), and transoral surgery (TOS) remains a valid treatment option for this population. This study aimed to evaluate the impact of adjuvant therapy on survival outcomes in this group.

[METHODS] This retrospective study analyzed data from the National Cancer Database (NCDB) for older adults (≥65 years) diagnosed with OPSCC and treated with primary TOS. Patients were stratified into low, intermediate, and high-risk groups according to specific pathological criteria. The survival benefit of adjuvant therapy was assessed using a multivariable Cox regression model.

[RESULTS] A total of 998 patients undergoing primary TOS for HPV-related OPSCC were classified in low (N = 347, 34.8 %), intermediate (N = 261, 26.1 %) and high (N = 390, 39.1 %) risk groups. Adjuvant treatment showed no significant benefit in the low (adjusted HR: 0.70; 95 % CI: 0.33-1.47) and intermediate (HR: 0.73; 95 % CI: 0.36-1.48) risk groups. Adjuvant treatment was beneficial in the high risk group (adjusted HR: 0.40, 95 % CI: 0.25-0.62), with adjuvant chemoradiotherapy (adjusted HR: 0.28 95 % CI: 0.16-0.48; p < 0.001) showing a slight advantage compared to radiotherapy alone (adjusted HR: 0.61, 95 % CI: 0.36-1.03).

[CONCLUSION] The findings suggest that adjuvant therapy should be selectively applied in older adults with OPSCC, with a significant survival benefit observed primarily in high-risk patients. Future studies are needed to confirm the safety and efficacy of treatment de-escalation strategies in this population.