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Head & neck: Oropharynx — definitive chemoRT and altered fractionation

Free question published 07 October 2026

Head & neckOropharynx — definitive chemoRT and altered fractionation

A 60-year-old man with a p16-negative T3 N1 oropharyngeal squamous cell carcinoma is being planned for definitive non-surgical treatment. He has normal renal function and good performance status. The multidisciplinary team agrees on radical radiotherapy delivered to 70 Gy with concurrent systemic therapy. Which statement best justifies the choice of concomitant rather than induction chemotherapy in this setting?

  1. AInduction chemotherapy gives a larger absolute survival benefit than concomitant chemotherapy at every single tumour site
  2. BChemotherapy adds no survival benefit in oropharyngeal cancer, so the choice of timing is irrelevant
  3. CChemotherapy gives greater survival benefit when delivered concomitantly with radiotherapy than as induction
  4. DChemotherapy benefit increases steadily with age, favouring induction in younger patients
  5. EConcomitant and induction chemotherapy are statistically equivalent, so the decision rests solely on toxicity

Why C is correct

The MACH-NC meta-analysis of over 16,000 patients showed the benefit of adding chemotherapy to locoregional treatment was consistent across tumour sites, but the benefit was higher when chemotherapy was given concomitantly with radiotherapy than as induction. Concomitant chemoradiotherapy is therefore the standard non-surgical approach for locally advanced disease.

And why the others are not

  • AWrong — the meta-analysis showed concomitant scheduling gave the greater benefit, not induction.
  • BWrong — the 5-year absolute survival benefit for oropharyngeal tumours was 8.1%, so chemotherapy clearly helps.
  • DWrong — chemotherapy benefit decreased with increasing age in MACH-NC; it does not favour induction in the young.
  • EWrong — the benefit of concomitant scheduling was greater than that of induction, so they are not equivalent.

Source MACH-NC meta-analysis — Meta-analysis of chemotherapy in head and neck cancer: comprehensive analysis by tumour site — Blanchard P, Baujat B, Holostenco V, et al. (MACH-NC Collaborative Group). Radiother Oncol 2011;100(1):33-40. DOI 10.1016/j.radonc.2011.05.036. PMID 21684027.

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