Extracapsular extension is associated with worse distant control and progression-free survival in patients with lymph node-positive human papillomavirus-related oropharyngeal carcinoma

The presence of extracapsular extension (ECE) in lymph node-positive head and neck squamous cell carcinoma (HNSCC) leads to poor locoregional control (LRC), distant control (DC) and overall survival (OS) [1–8]. Due to its poor prognosis, histologically identified ECE is an indication for more aggressive adjuvant treatment, with both an increased dose of post-operative radiotherapy (RT) and concurrent chemotherapy [9]. Evidence supporting this approach largely stems from two contemporaneous, separately designed and run, phase III randomized trials, EORTC 22931 and RTOG 95–01, and the meta-analysis of their pooled data [10–12].

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