Original Research—Head and Neck Surgery Utilization and Survival of Postoperative Radiation or Chemoradiation for pT1-2N1M0 Head and Neck Cancer Otolaryngology– Head and Neck Surgery 2018, Vol. 158(4) 677–684 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599817746391 http://otojournal.org Anna Lee, MD, MPH 1,2 , Babak Givi, MD 3 , Dylan F. Roden, MD, MPH 3 , Moses M. Tam, MD 4 , S. Peter Wu, MD 4 , Naamit K. Gerber, MD 4 , Kenneth S. Hu, MD 4 , and David Schreiber, MD 1,2 No sponsorships or competing interests have been disclosed for this article. Abstract Objective. To analyze the patterns of care and survival for pT1- 2N1M0 head and neck cancer based on receipt of surgery alone, surgery 1 postoperative radiotherapy (S 1 RT), or sur- gery 1 postoperative chemoradiotherapy (S 1 CRT). Study Design. Retrospective analysis. Setting. National Cancer Database. Subjects and Methods. We queried the database for patients with stage pT1-2N1M0 squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx between 2004 and 2012 who were treated with surgery with negative margins and no extracapsular extension. Logistic regression was used to assess predictors of receipt of postoperative treatment. Overall survival was assessed by the Kaplan-Meier method, and Cox regression analysis identified covariates that affected it. Results. There were 1598 patients included in this study: 566 (35.4%) received surgery alone; 726 (45.4%), S 1 RT; and 306 (19.1%), S 1 CRT. The 5-year overall survival was 68.8%, 74.0%, and 87.8%, respectively (P = .009 comparing S 1 RT and surgery alone, P \ .001 for all other comparisons). On multivariable logistic regression, academic centers were associ- ated with a decreased likelihood of S 1 RT (odds ratio = 0.71) and S 1 CRT (odds ratio = 0.66). Multivariable Cox regression demonstrated no difference in survival for S 1 RT over sur- gery alone (hazard ratio = 0.88, 95% CI = 0.70-1.09, P = .24); however, there was a survival benefit associated with S 1 CRT (hazard ratio = 0.57, 95% CI = 0.39-0.81, P = .002). Conclusion. Nearly 65% of patients with pT1-2N1 head and neck cancer with negative margins and no extracapsular extension received S 1 RT or S 1 CRT. Improvement in sur- vival was noted only for patients who received S 1 CRT. Keywords postoperative radiation, postoperative chemoradiation, head and neck cancer Received May 30, 2017; revised October 4, 2017; accepted November 15, 2017. E arly-stage (I-II) head and neck cancers are often suc- cessfully treated with surgery or radiation therapy alone. However, in locally advanced disease (stages III-IV), multimodality treatment is utilized to achieve locor- egional control. The most important prognostic factor in head and neck malignancies is nodal metastases, 1,2 and the presence of multiple lymph nodes, extracapsular extension (ECE), or positive margins is a clear indication for adjuvant treatment following primary surgery. Among patients with a single positive lymph node \ 3 cm without ECE, the benefit of adjuvant treatment is less clear. Per the guidelines of the National Comprehensive Cancer Network (NCCN; version 1.2017), radiation therapy can be considered for patients with N1 disease and no adverse features in the oral cavity or supraglottic larynx subsites but can be observed following surgery in the oro- pharynx, hypopharynx, or glottic larynx. Patients with N1 disease represented 19% of the sample in the large European Organization for Research and Treatment of Cancer (EORTC) 22931 study by Bernier et al 3 but were generally not included in the Radiation Therapy Oncology Group (RTOG) 9501 study. 4 Therefore, it is 1 Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, New York, USA 2 Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, USA 3 Department of Otolaryngology, New York School of Medicine, New York, New York, USA 4 Department of Radiation Oncology, New York School of Medicine, New York, New York, USA Corresponding Author: Anna Lee, MD, MPH, Department of Radiation Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Mail Stop #1211, Brooklyn, NY 11203, USA. Email: anna.lee@downstate.edu