News | Radiation Therapy | October 19, 2015

Reduced-intensity Chemoradiotherapy Effective for HPV-related Oropharynx Cancer

Study presented at ASTRO showed patients who received reduced dose experienced less side effects

reduced intensity chemoradiotherapy, HPV-related oropharynx cancer, ASTRO 2015

October 19, 2015 — For some patients with human papilloma virus (HPV)-related cancer of the tonsils and tongue, reduced intensity radiation therapy (RT) and chemotherapy may be as effective as standard-dose radiation and chemotherapy, and result in less acute side effects. This conclusion came from research presented at the American Society for Radiation Oncology’s (ASTRO’s) 57th annual meeting, Oct. 18-21 in San Antonio.

The incidence of cancer at the base of the tongue and tonsil is rapidly increasing and thought to be caused by HPV infection. The standard treatment for patients with HPV-related squamous cell carcinoma of the oropharynx is a seven-week course of 70 Gy of RT, in conjunction with a high-dose (100 mg/m2) of the chemotherapy drug Cisplatin for three cycles. Although this standard chemoradiotherapy protocol results in excellent cancer control and survival among patients, it produces substantial adverse side effects, such as chronic, acute difficulties in talking or swallowing, which may require a feeding tube; dry mouth; painful inflammation of the mucous membranes and/or digestive tract; tooth decay and necrosis of the jawbone.

This prospective, multi-institutional, phase II study assessed the use of reduced intensity chemoradiotherapy among 43 patients with favorable risk HPV-associated oropharyngeal squamous cell carcinoma who had a minimal history of smoking. Radiation therapy was reduced by 16 percent, to a six-week course of 60 Gy, and the chemotherapy dose was reduced by 60 percent overall, with low doses (30 mg/m2) of Cisplatin delivered concurrently for six weeks.

After patients completed chemoradiotherapy, the tumor site was biopsied and any lymph node regions that were originally cancer-positive were removed in order to determine the treatment’s efficacy. Of the 43 patients studied, 37 of them (86 percent) had no residual invasive tumor and no residual lymph node metastasis. The cancer remaining in the other six patients was microscopic. Follow-up was conducted for six to 36 months, with an average follow-up of 20.7 months, during which all patients were alive and had no evidence of cancer recurrence.

Symptoms and quality of life were evaluated using two patient-reported questionnaires – the National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Modified barium swallow studies assessed swallowing outcomes. Early findings suggest that reduced intensity chemoradiotherapy resulted in less acute toxicity and a decrease in side effects of mucositis (inflammation and of the mucous membranes lining the digestive tract), nausea, vomiting, swallowing difficulty and dryness of the mouth. Standard chemoradiotherapy regimens have reported feeding tube rates of up to 80 percent, approximately 10 percent of which were permanent. On the contrary, only 39 percent of patients in this study needed a feeding tube, none of which were permanent. Patients also reported that their swallowing function returned to almost normal, compared to baseline, pretreatment patient reports, and this was verified by the objective modified barium swallow studies, whereby patients’ swallowing difficulty is assessed using a fluoroscopic X-ray while they swallow various consistencies of food and liquids.

“Our study provides strong preliminary evidence that reduced intensity chemoradiotherapy may be as effective as standard dose chemoradiotherapy,” said lead study author Bhishamjit Chera, M.D., associate professor of radiation oncology at University of North Carolina School of Medicine. “With further study, this regiment may become the new standard of care for carefully selected patients with HPV-associated squamous cell carcinoma of the oropharynx. The results so far are certainly encouraging, and with longer follow-ups, we hope to confirm less long-term side effects, as well.”

Additional data is needed, so at this time reduced intensity treatment should only be given if patients are enrolled in carefully controlled clinical trials, concluded Chera. He and his team are currently conducting a follow-up study among certain patients, in which biopsies and lymph node removal is only done if a 12-week post chemoradiotherapy PET scan is suspicious for persistent cancer is currently being conducted.

For more information: www.astro.org

Related Content

IBA Releases Razor Nano Ionization Chamber
News | Proton Therapy | September 22, 2017
September 22, 2017 — IBA (Ion Beam Applications S.A.) announced the release of the Razor Nano Chamber, the smallest a
Penn Medicine Treats World's First Patient on Varian's Halcyon System
News | Radiation Therapy | September 22, 2017
September 22, 2017 — Varian Medical Systems announced a patient at Penn Medicine, with head & neck cancer, became
BrainLAB Announces FDA Clearance For Two New Indication-Specific Radiosurgery Software Applications
Technology | Treatment Planning | September 21, 2017
Brainlab announced that it has received U.S. Food and Drug Administration (FDA) clearance for Elements Spine SRS and...
Accuray Showcases CyberKnife and Radixact Systems at ASTRO 2017
News | Radiation Therapy | September 21, 2017
Accuray Inc. announced that data and first-hand experience with its advanced CyberKnife and Radixact Systems will be...
RayCare Oncology Information System Being Shown at ASTRO 2017
News | Radiation Therapy | September 20, 2017
RaySearch will be exhibiting its next-generation oncology information system (OIS) RayCare, among other highlights, at...
ProCure Proton Therapy Center New Jersey Celebrates Five-Year Cancer-Free Milestone for Prostate Cancer Patients
News | Proton Therapy | September 20, 2017
ProCure Proton Therapy Center in Somerset, N.J., recently celebrated the five-year cancer-free milestone for the first...
Varian to Showcase Latest Radiation Therapy Technologies and Software at ASTRO 2017
News | Radiation Therapy | September 19, 2017
Varian Medical Systems announced it will be demonstrating its new Halcyon platform and HyperArc high-definition...
Elekta to Highlight MOSAIQ Oncology Analytics at ASTRO Annual Meeting
News | Radiation Therapy | September 19, 2017
September 19, 2017 — Elekta will highlight its Mosaiq Oncology...
Double Targeting Ligands to Identify and Treat Prostate Cancer

The mice were imaged with small-animal PET/CT using 124I-RPS-027 (7.4 MBq [200 μCi]). Credit: JM Kelly et al., Department of Radiology, Weill Cornell Medicine, New York, NY

News | Prostate Cancer | September 14, 2017
Researchers have demonstrated a new, effective way to precisely identify and localize prostate cancer tumors while...
Overlay Init