Skip to main content
AAO-HNSF 2026 Annual Meeting & OTO EXPO Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.

Scientific Oral Presentation

Head and Neck Surgery

Does Adjuvant Chemotherapy Improve Outcomes in HPV+ Oropharyngeal Cancer with Extranodal Extension? A Systematic Review

Monday, October 19, 2026
1:24 PM - 1:30 PM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • Dominique T. Zarrella, BS

    Medical Student
    Uniformed Services University of the Health Sciences
    Bethesda, Maryland, United States

    • Co-Author(s)

  • John J. Caraway, MD

    Resident
    Walter Reed National Military Medical Center
    Bethesda, Maryland, United States

    • Senior Author(s)

  • PW

    Paul Wistermayer, MD

    Deputy Director of Surgical Services
    Walter Reed National Military Medical Center
    Bethesda, Maryland, United States

Introduction: Currently, management guidelines for HPV+ oropharyngeal squamous cell carcinoma (OPSCC) with extranodal extension (ENE) or positive surgical margins (PSM) recommend the use of adjuvant chemotherapy in addition to radiotherapy. However, this treatment paradigm is based on prior research involving HPV- OPSCC, and it remains unclear if adjuvant chemotherapy improves patient outcomes in HPV+ OPSCC with ENE or PSM. The purpose of this study is to conduct the first systematic review to examine whether adjuvant chemotherapy improves oncologic outcomes in HPV+ OPSCC with ENE and/or PSM.

Methods: A comprehensive literature search was conducted using PubMed, Embase, Web of Science, and Ovid All EBM Reviews. Studies met inclusion criteria if they compared survival, recurrence, and/or quality of life (QOL) outcomes for HPV+ OPSCC patients with ENE and/or PSM who received surgery plus adjuvant chemoradiotherapy (CRT) versus surgery plus radiotherapy (RT) alone. Study selection was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) strategy.

Results: The literature search returned 7,208 articles for initial review, of which 10 (14,257 participants) met criteria for inclusion. Meta-analysis was not feasible due to heterogeneity in outcome reporting. Included studies demonstrated that the addition of adjuvant CRT in patients with HPV+ OPSCC with ENE and/or PSM improved disease-free survival (DFS) but did not improve overall survival (OS). Additionally, the use of adjuvant CRT significantly worsened patient-reported QOL.

Conclusions: While adjuvant CRT is associated with improved DFS in HPV+ OPSCC with ENE and/or PSM, it does not confer an OS benefit and is associated with worse QOL. These findings suggest that surgery followed by adjuvant RT alone may be the preferred treatment approach, however prospective randomized controlled trials are needed to further define the role of adjuvant chemotherapy in this patient population.