“Perhaps this is the group that we need to focus on for an alternative approach as opposed to chemoradiation,” he said.
Explore This IssueFebruary 2012
Overall, though, Dr. Weber said, “non-surgical treatment is effective. We need more outcome and functional data than we have today.”
Wendell Yarbrough, MD, director of the Barry Baker Laboratory for Head and Neck Oncology at the Vanderbilt-Ingram Cancer Center in Nashville, lamented a lack of head-to-head studies comparing the two main approaches: surgery followed by radiation and chemoradiation and salvage surgery. He said it is HPV status, not treatment, that drives survival. “With two-year disease-free survival of less than 50 percent (in HPV-negative patients), why aren’t we treating these patients with surgery?”
Forgoing surgery could lead to bigger problems later, he said. “When we do get the failures (after chemoradiation) and are able to operate on them, obviously now the patients are having worse problems.”
But salvage surgery has been found to have a 21 percent rate of five-year overall survival. “Surgical salvage for oropharyngeal cancer,” Dr. Yarbrough said, “just doesn’t work.”