After presentation of the study by Cheng and colleagues at the 2015 European Cancer Congress, formal discussant Vincent Grégoire, MD, PhD, Department of Radiation Oncology, UCL St-Luc University Hospital, Brussels, Belgium, was cautious in endorsing a surgical approach for stage III and IV oropharyngeal and hypopharyngeal cancers.

“This paper shows that, in Taiwan, it is better to have oropharyngeal cancer than hypopharyngeal cancer, and it is better to have stage III disease than stage IV. This is the same all over the world, but in Taiwan, it is also better to have surgery than not. However, the environment and other considerations in Taiwan may be different,” he said.

“Patient selection and potential bias is an important issue in retrospective studies,” he continued. “We need to be sure about the methodology. Surgical treatments were unclear in the data. Was radiation used for curative intent or palliation? Was the radiotherapy dose optimized? We can’t compare apples and oranges,” he stated.

“There is no doubt that we need to know which approach is better—surgical vs nonsurgical—and the outcomes studied should be efficacy, toxicity, and side effects, such as speech and swallowing,” he added.

Dr. Grégoire concluded, “This study should be hypothesis-generating. It is interesting data, but I would be very careful about basing policy guidelines on these data, even in Taiwan.” ■

Disclosure: Dr. Grégoire reported no potential conflicts of interest.