HEAD AND NECK Primary surgery results in no survival benefit compared to primary radiation for oropharyngeal cancer patients stratified by high-risk human papilloma virus status Stein Lybak 1,2 • Borghild Ljøkjel 1 • Hilde Haave 1 • A ` sa Karlsdottir 3 • Olav K. Vintermyr 2,4 • Hans Jørgen Aarstad 1,2 Received: 25 June 2015 / Accepted: 11 July 2016 Ó Springer-Verlag Berlin Heidelberg 2016 Abstract We changed the primary oropharynx squamous cell carcinoma (OPSCC) treatment recommendation from primary radiation therapy (RT) to tumor surgery and neck dissection, followed by RT around the year 2000 with apparently improved survival. However, high-risk human papilloma virus (hr-HPV)-16-caused OPSCCs have increased during this period. Furthermore, hr-HPV? OPSCC carry a better prognosis than hr-HPV-negative patients. We have, therefore, evaluated the 5-year survival in the period from 1992 to 1999 versus 2000 to 2008 stratified by hr-HPV tumor infection status. Ninety-six OPSCC patients were treated from 1992 to 1999 compared with 136 patients from 2000 to 2008. The 5-year disease- specific survival (DDS) and overall survival (OS) were recorded, while the health-related quality of life (HRQoL) scores were obtained from some of the cured patients. Thirty-eight (40 %) in the first period and 86 OPSCCs (63 %) in the second period were hr-HPV?. In the first period, 16 versus 62 patients in the last period were treated by neck dissection, primary tumor surgery, and RT. DSS among all the hr-HPV-negative patients in the first period was 51 versus 55 % in the second period, and the corre- sponding OS was 33 versus 31 %, respectively. The DSS among all the hr-HPV? patients was 78 % in the first period versus 77 % in the second period, while the OS was 71 versus 69 %, respectively. The HRQoL scores among successfully treated patients were worse following surgery, plus RT than RT only. The hr-HPV-adjusted 5-year sur- vival in OPSCC patients was similar between the two time periods. A decreased HRQoL was associated with surgical therapy, which indicates that hr-HPV? OPSCC patients may be treated by primary RT followed by major surgery only if RT treatment fails. Keywords Neoplasms Á hr-HPV Á Head and neck Á Prognosis Á Surgery Á Oropharynx Introduction Treatment results for oropharyngeal squamous cell carci- noma (OPSCC) patients have been unsatisfactory. Zhen et al. [1] have, e.g., reported results from over 16,000 base of the tongue carcinoma patients from the National Cancer Data Bank of the US between 1985 and 1996, thereby demonstrating a 2-year overall survival (OS) of 48.7 % and a 5-year OS of 27.8 % among these patients. Similar fig- ures have also been reported from the Nordic countries [2, 3]. Hence, improved treatment programs for OPSCC patients were needed. As part of this effort, we changed our treatment recommendations from the first-line treatment with radiation therapy (RT) to the first-line treatment by surgery with postoperative RT in approximately the year 2000. Following this changed treatment regimen, we observed improved patient survival [4]. A previous version of the paper has been presented orally at IFHNOS 5th World Congress and AHNS 2014 Meeting. & Hans Jørgen Aarstad hans.aarstad@uib.no 1 Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, 5021 Bergen, Norway 2 Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway 3 Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway 4 Department of Pathology, Haukeland University Hospital, Bergen, Norway 123 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-016-4203-2