In a single-center retrospective cohort study reported in JAMA Oncology, C. Jillian Tsai, MD, PhD, and colleagues found that a systematic approach of reducing radiotherapy dose and target volume to elective treatment regions was associated with a high rate of locoregional control in patients with human papillomavirus (HPV)-associated oropharyngeal carcinoma receiving definitive concurrent chemoradiotherapy.
The study included 276 consecutive patients with HPV-positive oropharyngeal carcinoma receiving concurrent chemoradiotherapy between March 2017 and July 2019 at Memorial Sloan Kettering Cancer Center. Patients received radiotherapy at 30 Gy in 15 fractions to elective nodal and subclinical regions, followed by a cone-down of 40 Gy in 20 fractions to gross disease, for a total dose of 70 Gy. High retropharyngeal nodal basins in the node-negative neck and bilateral levels IB and V basins were omitted. The primary outcome measure was 24-month locoregional control.
A total of 213 patients (77.2%) received high-dose cisplatin, with 172 (62.3%) completing a cumulative dose of 300 mg/m2. Other chemotherapy regimens included weekly carboplatin with paclitaxel or fluorouracil. Median follow-up was 26 months (range = 21–32 months).
A total of eight patients (2.9%) developed locoregional recurrence, including seven at the primary site or gross nodes that received a total dose of 70 Gy, and one with a persistent node not previously identified as gross disease that received a total dose of 30 Gy. At 24 months, locoregional control was 97.0%, progression-free survival was 88.0%, distant metastasis–free survival was 95.2%, and overall survival was 95.1%. No difference in locoregional control was observed between patients receiving high-dose cisplatin vs other chemotherapy regimens (hazard ratio = 0.8, 95% CI = 0.2–3.5, P = .71).
This cohort study found that the evaluated de-escalation strategy for elective regions showed favorable clinical outcomes and quality-of-life profiles. Long-term follow-up data will help affirm the efficacy of this strategy as a care option for treating HPV-associated oropharyngeal carcinoma with primary concurrent chemoradiotherapy.— C. Jillian Tsai, MD, PhD, and colleagues
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During treatment, 17 patients (6.2%) required a feeding tube, with a median duration of feeding tube dependence of 5 months (range = 1–23 months). At 24 months, quality-of-life composite scores on the Gothenburg Trismus Questionnaire were comparable or better than baseline for jaw-related problems, pain, social contact, eating, speech, and swallowing; scores for senses, dry mouth, muscular tension, and cognitive functioning improved over time but did not return to baseline levels.
The investigators concluded, “This cohort study found that the evaluated de-escalation strategy for elective regions showed favorable clinical outcomes and quality of life profiles. Long-term follow-up data will help affirm the efficacy of this strategy as a care option for treating HPV-associated oropharyngeal carcinoma with primary concurrent chemoradiotherapy.”
Nancy Y. Lee, MD, of the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by grants from the National Institutes of Health and National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.