The crucial question: does adjuvant radiotherapy confer a survival benefit in pN1 oral squamous cell carcinoma (OSCC)? - A retrospective analysis

OBJECTIVE: Despite continuous research on the role of adjuvant therapy in the pN1 setting in Oral Squamous Cell Carcinoma (OSCC), clear recommendations for or against its use remain lacking. The objective of this study is to further strengthen the existing evidence base and support informed clinical decision-making. MATERIALS AND METHODS: This retrospective analysis included all patients with primary pT1-2 pN1 OSCC without extracapsular spread who underwent surgical treatment at the Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin. Survival analyses were performed using Kaplan-Meier methods and Cox regression models for the overall cohort as well as after propensity score matching (PSM). RESULTS: A total of 58 patients (male: 34 (58.6%), female: 24 (41.4%)) with a mean age of 63.6 years were included. In the overall cohort, there were no significant differences in overall survival (OS) or recurrence free survival (RFS) between patients treated with surgery alone and those who received adjuvant therapy (p = 0.628; p = 0.244). In contrast, following PSM, adjuvant therapy was associated with a reduced risk of recurrence, as reflected by improved RFS (HR 0.21 (CI: 0.02-0.85, p = 0.029)). CONCLUSION: In summary, our findings suggest an association between adjuvant therapy and improved RFS in patients with T1-2 pN1 OSCC, indicating a potential oncological benefit that should be considered in the context of individual clinical characteristics and balanced against potential treatment-related adverse effects.