Exclusive Radio±chemoTherapy versus upfront Surgery in the treatment of HPV-related localized or locally ADvanced Oropharyngeal squamous cell Carcinoma (RT-SHADOC): a tricentric study of efficacy, tolerance and quality of life

Abstract Background The treatment of stage I-III HPV + oropharyngeal squamous cell carcinoma (HPV-OPSCC) is based on either surgery ± adjuvant therapy or exclusive radio ± chemotherapy. We sought to compare these two therapeutic strategies in terms of efficacy, tolerance and quality of life (QoL). Methods Patients treated for stage I-III HPV-OPSCC from 2010 to 2021in 3 academic centers were included and sorted according to the treatment strategy: surgery or exclusive radio ± chemotherapy. Efficacy and tolerance were retrospectively assessed, and QoL was prospectively evaluated using QoL assessment instruments. Results Eighty-three patients were included, 21 underwent surgery and 62 definitive radio-±chemotherapy. 2-year progression-free survival (PFS) and overall survival (OS) were respectively 80% and 86% in the surgical group and 92% and 95% in the non-surgical group, with no significant difference. At the end of treatment, 64.5% of patients presented a grade III symptom, without significant difference between the two groups. No patient had late grade III toxicity at 24 months. Forty-five patients (11 in the surgical group, 34 in the nonsurgical group) participated in the prospective quality-of-life analysis. Patients reported significantly more fatigue and loss of appetite after surgery, whereas patients in the radio ± chemotherapy group described significantly more salivary and oral problems and difficulty swallowing. The global quality of life score tended to be better in the radio ± chemotherapy group (EORTC QLQ-C30 77.6 vs 65.2, p = 0.07). Conclusion No significant difference in terms of efficacy, physician-reported toxicity and patient-reported quality of life was found between surgery and radio ± chemotherapy in the treatment of stage I-III HPV-OPSCC.