Feasibility of Dose-escalated Hypofractionated Chemoradiation in Human Papilloma Virus-negative or Smoking-associated Oropharyngeal Cancer. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Meade, S.; Gaunt, P.; Hartley, A.; Robinson, M.; Harrop, V.; Cashmore, J.; Wagstaff, L.; Babrah, J.; Bowden, S.J.; Mehanna, H.; Sanghera, P.
• Is Part Of: Clinical oncology. Volume 30:Issue 6(2018)
• Page Start: 366
• Page End: 374
• Publication Date: 2018-06
• Subjects: Accelerated hypofractionation -- human papilloma virus -- oropharyngeal cancer -- smoking; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2018.01.015
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: Oropharyngeal squamous cell carcinoma (OPSCC) can be divided into favourable and poor prognostic groups by association with human papilloma virus (HPV) and smoking. This study prospectively investigated a dose-intensified schedule in poor/intermediate prognosis OPSCC. Materials and methods: Patients with p16/HPV-negative or p16-positive N2b OPSCC with a greater than 10 pack-year smoking history were eligible. Patients were planned to receive 64 Gy in 25 fractions with cisplatin. The primary end point was absence of grade 3 mucositis at 3 months. Results: Fifteen patients were recruited over 14 months. All patients completed a minimum of 2 years of follow-up. All patients completed full-dose radiotherapy within a median treatment time of 32 days (31–35). Grade 3 mucositis was absent in all patients at 3 months. There was one grade 4 toxicity event due to cisplatin (hypokalaemia). Complete response rates at 3 months were 100% and 93% for local disease and lymph nodes, respectively. One patient developed metastatic disease and subsequently died. Overall survival at 2 years was 93% (95% confidence interval 61–99%). Conclusions: The schedule of 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with poor and intermediate prognosis OPSCC. Highlights: Feasibility study of the use of hypofractionated chemoradiotherapy in high-risk oropharyngeal cancer. Study findings confirm tolerability of treatment. Patient selection based on biological status of patient. Forms an investigational arm of the CompARE study.