Patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinomas may have higher chances of being cured if treated with reduced doses of radiation, according to a new study published in the Journal of Clinical Oncology.
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Papillomavirus-positive oropharynx cancers, or cancers of the tonsils and back of the throat, have increased in number over recent years. In particular, younger patients have demonstrated higher rates of HPV-associated oropharyngeal squamous cell carcinoma. Definitive chemoradiation has been shown to produce high cure rates for patients with the cancer, but also long-term toxicity, such as swallowing, eating, and nutritional issues, as well as overtreatment in some patients.
"Younger patients may have to deal with these side effects for decades after cancer treatment. We want to help improve our patients' quality of life," said Barbara Burtness, MD, Professor of Medicine (Medical Oncology), Yale Cancer Center.
A study led by Shanthi Marur, MD, Johns Hopkins University, has shown that reducing radiation doses may limit long-term toxicity and overtreatment in some patients with HPV-associated oropharyngeal squamous cell carcinoma. Researchers conducted a phase II trial to evaluate whether complete clinical response to induction chemotherapy could be used to select patients with HPV-associated oropharyngeal squamous cell carcinoma for reduced radiation dose as a means of reducing long-term toxicity. A sample pool of 80 patients were chosen with HPV16 or p16-positive, stage 3-4 oropharyngeal squamous cell carcinoma to receive three cycles of induction chemotherapy with cisplatin, paclitaxel, and cetuximab. Fifty-six patients (70%) achieved a complete clinical response, and 51 of them continued to cetuximab with intensity-modulated radiation therapy (54 Gy). Those with less than a complete response to chemotherapy received 69.3 Gy radiation therapy and cetuximab.
After a median follow-up of 35.4 months, 2-year progression-free survival and overall survival rates were 80% and 94%, respectively, for those patients treated with 54 Gy of radiation. After 12 months, fewer patients treated with a radiation dose ≤ 54 Gy had difficulty swallowing (40% vs 89%; P = .011) or had impaired nutrition (10% vs 44%; P = .025) compared with patients who received 69.3 Gy of radiation (n = 9).
Researchers concluded that patients with HPV-associated oropharyngeal squamous cell carcinoma who respond to induction chemotherapy can benefit from reduced-dose intensity-modulated radiation therapy with concurrent cetuximab. Further research is required to validate intensity-modulated radiation therapy as an agent for improving cure rates and favorable outcomes.
