[Clinical study on induction chemotherapy combined with concurrent chemoradiotherapy for oropharyngeal squamous cell...

Objective: To investigate the efficacy and safety of non-surgical comprehensive treatment methods for patients with locally advanced oropharyngeal squamous cell carcinoma (OPSCC) and to analyze the impact of HPV (human papilloma virus) status on the patients' prognoses. Methods: A retrospective analysis was conducted on 152 patients with advanced OPSCC treated with non-surgical comprehensive treatment methods at the Department of Otolaryngology Head and Neck Surgery of the PLA General Hospital from October 2010 to October 2024. There were 114 males and 38 females, aged from 38 to 70 years, with a median age of 55.5 years. The treatments included induction chemotherapy (IC)+concurrent chemoradiotherapy (CCRT)±epidermal growth factor receptor (EGFR) molecular targeted therapy, including 126 patients treated with EGFR molecular targeted drugs during CCRT (124 with nimotuzumab+2 with cetuximab) and 32 patients with PD-1 immunotherapy during induction chemotherapy. Helical tomotherapy (HT) and intensity-modulated radiotherapy (IMRT) techniques were used in radiotherapy. The adverse reactions of chemoradiotherapy were assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5. survival rates were analyzed using the Kaplan-Meier method and Cox regression analysis. Results: The patients were followed up for 3 to 120 months, with an average follow-up time of 34.4 months. All 152 patients completed the planned radiotherapy and chemotherapy cycles. The 2-year and 3-year overall survival (OS) rates for all patients were 86.8% and 74.6%, respectively, and the progression-free survival (PFS) rates were 83.5% and 73.3%, respectively. In the p16+ patients (n=71), the 2-year and 3-year OS rates were 98.9% and 93.2% respectively, and the PFS rates were 97.6% and 91.1% respectively. For p16- patients (n=33), the 2-year and 3-year OS rates were 77.2% and 61.4% respectively, and the PFS rates were 74.6% and 58.5% respectively. The p16+ patients showed the higher OS and PFS than p16- patients (χ² values were 7.27 and 6.64 respectively, and both P values were <0.05). After treatment, 127 cases (83.3%) developed grade 3 oropharyngeal mucositis, and 7 cases (4.6%) required nasogastric feeding or parenteral nutrition. No patients underwent gastrostomy, and all patients were able to tolerate the adverse reactions. Conclusion: Non-surgical comprehensive therapy (IC+CCRT±EGFR inhibitors) is an effective treatment modality for advanced OPSSC, and patients can generally tolerate the associated adverse reactions. Moreover, p16+ patients exhibit a higher survival rate compared to p16- patients.