KEY POINTS
- This multicenter retrospective cohort included 240 patients with American Joint Committee on Cancer seventh-edition T1–2N1–2a head and neck squamous cell carcinoma; 234 patients (97.5%) had oropharyngeal tumors and 21% were human papillomavirus-negative.
- Curative-intent radiotherapy alone was delivered to 126 patients, while 114 patients received concurrent platinum-based chemoradiotherapy; inverse probability of treatment weighting was used to balance measured baseline characteristics.
- Concurrent chemoradiotherapy improved the primary endpoint of progression-free survival compared with radiotherapy alone: adjusted hazard ratio 0.42 (95% confidence interval 0.19–0.93; p=0.03).
- No statistically significant overall survival benefit was observed: adjusted hazard ratio 0.50 (95% confidence interval 0.20–1.24; p=0.14).
- The progression-free survival signal appeared more pronounced in T2N1–2a disease, but the treatment-by-T-stage interaction was not significant (p=0.76). Treatment-related toxicity was not systematically collected.
CLINICAL TAKEAWAY
Concurrent chemotherapy may improve disease control in selected patients with T2 primary tumors and low-volume nodal disease, but an overall survival advantage was not demonstrated. The findings do not justify routine treatment escalation because subgroup interaction testing was negative, toxicity data were unavailable, and residual confounding remains possible in this retrospective analysis.