In HPV-related disease, the approach linked to high cure rates, reduced side effects
THURSDAY, Sept. 28, 2017 (HealthDay News) — For patients with human papilloma virus (HPV)-related oropharynx squamous cell carcinoma (OPSCC), an aggressive reduction of radiation therapy can maintain excellent cure rates while reducing post-treatment side effects, according to a study presented at the annual meeting of the American Society for Radiation Oncology (ASTRO), held from Sept. 24 to 27 in San Diego.
Daniel J. Ma, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a single-arm phase II trial involving patients with p16+ OPSCC, ≤10 pack-year smoking history, and negative margins. Patients received 30 Gy delivered over 12 days along with weekly docetaxel (cohort A; 37 patients) or the same treatment plus a simultaneous integrated boost to nodal levels with extracapsular extension to 36 Gy (cohort B, 43 patients).
The researchers found that local/regional control was 95 percent, distant control was 94 percent, and disease-free survival was 89 percent during a median follow-up of 24 months. Between pre-treatment and 12-month follow-up there was improvement in swallowing function; no patients required feeding tube placement. Grade 2 toxicity rates were 12, 1, and 10 percent, while grade ≥3 toxicity rates were 3, 0, and 0 percent, respectively, at pre-treatment, one year, and two years’ post-radiotherapy, respectively. University of Michigan Xerostomia-Related Quality of Life scores worsened after treatment, while there was no change in other quality of life measures.
“Several research groups are pursuing an incremental approach to de-escalating treatment, such as using 15 percent less radiation dose. Our trial took a different approach — testing whether we could cut the dose by half. Our findings indicate that this more aggressive approach toward treatment reduction can be viable for appropriately selected patients,” Ma said in a statement.
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