Three new studies exploring treatment de-escalation of HPV-associated oropharynx squamous cell carcinoma added to data showing it's possible to reduce toxicity without jeopardizing oncologic outcomes.
The head and neck cancer community has been working to de-escalate treatment for human papillomavirus –associated oropharynx squamous cell carcinomas for several years in hopes of preserving oncologic outcomes while reducing treatment toxicity.
He noted, however, that "the optimal combination of de-intensification of radiation dose with or without systemic therapy, and the extent to which treatment attenuation can be safely diminished for different pathologic risk factors, remains unclear.
Meanwhile, toxicity was substantially lower in the 54 Gy group. Patients reported better short-term outcomes, particularly less pain at 1 month, and lower overall symptom burdens. Three months after radiation, patients in this group had lost a median of 6% of their body weight vs 12.6% in the higher dose group; they also required less use of feeding tubes. There was a grade 4 carotid artery injury with 70 Gy but no grade 4 injuries with 54 Gy.
To counter the problem, investigators at the university irradiated a smaller area of the contralateral neck than usual. Given the results, the approach has become our institutional standard for contralateral neck irradiation, said Molitoris.
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