Survival outcomes of radiotherapy alone versus concurrent chemoradiotherapy in T1–2 head and neck cancer with low-volume disease: A multicenter cohort study

Background The optimal treatment strategy between definitive radiotherapy and concurrent chemoradiotherapy (CCRT) for patients with T1–2 head and neck cancer with low-volume nodal disease remains unclear due to limited supporting data. This study aimed to compare overall survival (OS) and progression-free survival (PFS) between the two treatment modalities. Methods Patients with AJCC 7th edition stage T1–2N1–2a head and neck squamous cell carcinoma (HNSCC) were collected from multiple research centers, including the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (NCC), the University Health Network (UHN), and Quebec, Canada. Inverse probability of treatment weighting (IPTW) was applied to balance baseline differences. Kaplan-Meier analysis and Cox proportional hazards models were used to compare OS and PFS between the two groups. Results A total of 240 patients were included, with a median age of 57.8 years (IQR 52.0–65.1); 51 patients (21%) were HPV-negative. After IPTW adjustment, multivariable Cox analysis showed that CCRT did not provide a significant OS benefit compared with radiotherapy alone (hazard ratio [HR], 0.50; 95% CI, 0.20–1.24; P = 0.14). However, CCRT was associated with a significant improvement in PFS (HR, 0.42; 95% CI, 0.19–0.93; P = 0.03). Consistent with the NRG-HN002 trial, which showed a 9.7% absolute reduction in locoregional failure with CCRT relative to radiotherapy alone. Conclusions This multicenter study demonstrated that while CCRT conferred limited OS benefit in patients with stage T1–2N1–2a HNSCC, it improved tumor progression control in a subset of patients. Careful evaluation of survival benefit versus treatment-related toxicity is warranted, and larger prospective studies are needed to validate these findings.