Reduced Radiation Treatment May Benefit Patients with HPV Oropharynx Cancers

A team of researchers has found that reduced radiation in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has a high cure rate and reduced risk for swallowing dysfunction and toxicity in patients.

The study included 80 patients enrolled at Eastern Cooperative Oncology Group-American College of Radiology Imaging Network with newly diagnosed stage III or IV OPSCC HPV16 or p16 immunohistochemity (IHC). The median age of participants was 57 years with a history of less than 10 packs a year of cigarette smoking. Participants received 3 cycles of induction chemotherapy with cisplatin, paclitaxel, and cetuximab.
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Researchers determined the clinical response at primary and involved nodal sites within 14 days of induction chemotherapy by performing a complete head and neck clinical examination using fiberoptic nasopharyngolaryngoscopy and CT or magnetic resonance imaging.

Patients with complete clinical response to the primary site, defined as the complete disappearance of the primary lesion, received intensity-modulated radiation therapy dosage of 54 Gy with weekly cetuximab, and participants without complete clinical response to the primary site received a dosage 69.3 Gy and cetuximab to the regions.

Overall, 56 patients achieved complete clinical response to the primary site, while 51 continued to receive cetuximab and intensity-modulated radiation therapy dosage at 54 Gy. The 2-year progression survival rate and overall survival rates was 80% for participants with a complete clinical response treated with 54 Gy of radiation, and the overall survival was 94%. Patients who smoked less than 10 packs a year and less severe tumors had a 96% complete clinical response and a 96% overall survival rating on a radiation dosage of 54 Gy.

In the study, only 40% patients of patients had difficulty swallowing, and 10% had impaired nutrition after 12 months of 54 Gy radiation dose.

The findings suggest that reduced radiation treats HPV OPSCC in patients with low-volume tumors and minimal smoking history while reducing the side effects of toxicity, impaired nutrition, and swallowing dysfunction.

—Melissa Weiss

Reference:

Marur S, Li S, Cmelak AJ, et al. E1308: phase II trial of induction chemotherapy followed by reduced-dose radiation and weekly cetuximab in patients with HPV-associated resectable squamous cell carcinoma of the oropharynx—ECOG-ACRIN Cancer Research Group [published online December 28, 2016]. Journal of Clinical Oncology. doi:10.1200/JCO.2016.68.3300.