Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study

Chen, Allen M.; Felix, Carol; Wang, Pin-Chieh; Hsu, Ruey-Feng; Basehart, Vincent; Garst, Jordan H.; Beron, P.J.; Wong, Deborah Jean Lee; Rosove, Michael H.; Rao, Shyam; Melanson, Heather; Kim, Edward; Palmer, Daphne; Qi, Lihong; Kelly, Karen; Steinberg, Michael L.; Kupelian, Patrick A.; Daly, Megan E.

doi:10.1016/s1470-2045(17)30246-2

Cited by 280 publications

(234 citation statements)

References 42 publications

(44 reference statements)

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“…4 The HPVrelated OPC has different characteristics from classic HNSCC, which is caused by habitual smoking and alcohol consumption. 6,7 In contrast, the prognostic role of HPV status in non-OPC remains to be determined. 6,7 In contrast, the prognostic role of HPV status in non-OPC remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

Platelet count and platelet‐lymphocyte ratio as prognostic markers for head and neck squamous cell carcinoma: Meta‐analysis

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Platelet count and platelet‐lymphocyte ratio as prognostic markers for head and neck squamous cell carcinoma: Meta‐analysis

et al. 2018

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“…Although some studies have reported that reduced radiation therapy is feasible for children and adolescents with NPC-and HPV-positive oropharyngeal cancer, 8,9,11,17,18 it is unclear whether reduced-dose radiation for adults with NPC with IMRT can achieve satisfactory results. Although some studies have reported that reduced radiation therapy is feasible for children and adolescents with NPC-and HPV-positive oropharyngeal cancer, 8,9,11,17,18 it is unclear whether reduced-dose radiation for adults with NPC with IMRT can achieve satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

“…11 Fortyfour patients with complete or partial remission to IC received chemoradiotherapy with 54 Gy radiation doses. NPC-and HPVpositive oropharyngeal cancer are both virus-related tumors and are sensitive to radiotherapy and chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Prognosis of nasopharyngeal carcinoma with insufficient radical dose to the primary site in the intensity‐modulated radiotherapy era

Xie

Guo

et al. 2019

Head & Neck

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Background It was reported that reduced radiotherapy is feasible for children with nasopharyngeal carcinoma (NPC) and papilloma virus‐positive oropharyngeal cancer. Therefore, we performed this study to explore the prognosis of reduced‐dose radiation in adult with NPC. Methods Between 2004 and 2013, we retrospectively analyzed 19 patients histologically diagnosed with NPC, who received <66 Gy radiation therapy. Ten patients receiving <54 Gy to the primary site were group A. Nine patients receiving ≥54 Gy were group B. Results Thirteen patients received induction chemotherapy (IC) for two or three cycles. In group A, the 5‐year overall survival (OS) was 50.0%. For group B, the 5‐year OS, locoregional relapse‐free survival, progression‐free survival, and distant metastasis‐free survival were 88.9%, 100.0%, 88.9%, and 88.9%. Group B had a better prognosis than group A on OS (88.9% vs 50.0%, P = .03). Conclusion Patients receiving ≥54 Gy but <66 Gy with IC achieved good local control and long‐term survival.

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“…Additionally, patients without external beam radiation therapy at doses of 54 to 75 Gy or failing to complete the course of radiation between 25 and 75 days were excluded to omit patients with untrusted dosing and time intervals. A lower threshold of 54 Gy was used, as this is the lowest dose to date tested to our knowledge . Patients with follow‐up of ≤2 months were excluded to account for immortal time bias.…”

Section: Methodsmentioning

confidence: 99%

Practice patterns and outcomes following radiation dose de‐escalation for oropharyngeal cancer

et al. 2019

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Objectives/Hypothesis Numerous trials are evaluating radiotherapy (RT) de‐escalation for human papillomavirus (HPV)‐mediated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Herein, we evaluated the degree to which de‐escalated RT is delivered in the United States, as well as comparative outcomes with full‐dose RT as stratified for HPV status. Study Design Retrospective database review. Methods We identified patients diagnosed with OPSCC in the National Cancer Database, excluding those with stage I/II disease, unknown HPV status, receiving surgery or not receiving external beam radiation therapy to the primary site, receipt of radiation doses >75 or <54 Gy, radiation treatment course duration <25 or >75 days, and unknown or inadequate (<2 months) follow‐up. Multivariable logistic regression analysis identified variables associated with delivery of de‐escalated RT (<66 Gy). Overall survival of HPV+ and non–HPV‐mediated (HPV−) disease was compared between full‐dose and de‐escalated approaches. Results Altogether, 617 and 551 patients were HPV+ and HPV−, respectively. De‐escalated RT was delivered in 16.9% HPV+ and 15.2% of HPV− disease, respectively. Older patients and omission of systemic therapy were more likely to receive de‐escalated RT. In HPV+ patients, 3‐ and 5‐year survival rates were 83% and 80% in the de‐escalated cohort versus 83% and 78% in the full‐dose group (P = .83). In HPV− patients, corresponding 3‐ and 5‐year survival rates were 29% and 23% versus 61% and 51% (P = .001). Conclusions National utilization of de‐escalated RT for OPSCC is low (15%–20%), but does not seem to impact overall survival in HPV+ (but not HPV−) patients. The caveats of this heterogeneous, retrospective analysis require corroboration from a number of ongoing randomized trials. Level of Evidence 2c Laryngoscope, 130:E171–E176, 2020

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Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study

Abstract: University of California.

Cited by 280 publications

References 42 publications

Platelet count and platelet‐lymphocyte ratio as prognostic markers for head and neck squamous cell carcinoma: Meta‐analysis

Platelet count and platelet‐lymphocyte ratio as prognostic markers for head and neck squamous cell carcinoma: Meta‐analysis

Prognosis of nasopharyngeal carcinoma with insufficient radical dose to the primary site in the intensity‐modulated radiotherapy era

Practice patterns and outcomes following radiation dose de‐escalation for oropharyngeal cancer

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