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Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer.

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Sher, DJ; Pham, N-L; Shah, JL; Sen, N; Williams, KA; Subramaniam, RM; Moore, W; Chorley, R; Ahn, C; Khan, SM
Published in: Int J Radiat Oncol Biol Phys
March 15, 2021

PURPOSE: The required elective nodal dose and volumes for head and neck intensity modulated radiation therapy have largely been extrapolated from conventional radiation therapy fields. In this prospective, dual-center, phase 2 study, we investigated the efficacy and tolerability of reduced elective nodal volume and dose in oropharyngeal and laryngeal squamous cell carcinoma. METHODS AND MATERIALS: Patients with newly diagnosed squamous cell carcinoma of the oropharynx and larynx were eligible for enrollment. Each lymph node was characterized as involved or suspicious based on imaging criteria. For oropharynx cancer, only involved and immediately adjacent stations were treated to 40 Gy in 20 fractions. In larynx patients, at least bilateral levels II and III were treated to 40 Gy, with level IV treated only if level III was involved. Involved and suspicious nodes were then boosted with 30 Gy and 24 Gy in 15 fractions, respectively. Concurrent chemotherapy was required for stage T3N0-1 and IVA/B patients. The primary endpoint of the study was solitary elective volume recurrence, with secondary endpoints including patterns of failure and patient-reported outcomes. RESULTS: A total of 72 (51 oropharynx, 21 larynx) patients completed treatment on this trial from January 2017 through November 2018. The stages at presentations were 5, 17, and 50 stage I-II, III, and IV, respectively, with 90% treated with chemoradiation therapy. At a median follow-up of 24.7 months for surviving patients, there have been no solitary elective nodal recurrences. Seven patients developed a nodal recurrence, 5 of which were in-field and 2 were elective with synchronous in-field recurrence. Patient-reported outcomes assessment at 1 year showed superior or equivalent outcomes compared with baseline, except for saliva and taste measures. CONCLUSIONS: The results of this trial suggest that elective dose and volume reduction is oncologically sound for oropharyngeal and laryngeal cancer treated with intensity modulated radiation therapy, with promising quality-of-life outcomes.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

March 15, 2021

Volume

109

Issue

4

Start / End Page

932 / 940

Location

United States

Related Subject Headings

  • Squamous Cell Carcinoma of Head and Neck
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Dosage
  • Prospective Studies
  • Patient Reported Outcome Measures
  • Oropharyngeal Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neck
  • Middle Aged
 

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Sher, D. J., Pham, N.-L., Shah, J. L., Sen, N., Williams, K. A., Subramaniam, R. M., … Khan, S. M. (2021). Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer. In Int J Radiat Oncol Biol Phys (Vol. 109, pp. 932–940). United States. https://doi.org/10.1016/j.ijrobp.2020.09.063
Sher, David J., Nhat-Long Pham, Jennifer L. Shah, Neilayan Sen, Kimberly A. Williams, Rathan M. Subramaniam, William Moore, Regina Chorley, Chul Ahn, and Saad M. Khan. “Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer.” In Int J Radiat Oncol Biol Phys, 109:932–40, 2021. https://doi.org/10.1016/j.ijrobp.2020.09.063.
Sher DJ, Pham N-L, Shah JL, Sen N, Williams KA, Subramaniam RM, et al. Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer. In: Int J Radiat Oncol Biol Phys. 2021. p. 932–40.
Sher, David J., et al. “Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer.Int J Radiat Oncol Biol Phys, vol. 109, no. 4, 2021, pp. 932–40. Pubmed, doi:10.1016/j.ijrobp.2020.09.063.
Sher DJ, Pham N-L, Shah JL, Sen N, Williams KA, Subramaniam RM, Moore W, Chorley R, Ahn C, Khan SM. Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer. Int J Radiat Oncol Biol Phys. 2021. p. 932–940.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

March 15, 2021

Volume

109

Issue

4

Start / End Page

932 / 940

Location

United States

Related Subject Headings

  • Squamous Cell Carcinoma of Head and Neck
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Dosage
  • Prospective Studies
  • Patient Reported Outcome Measures
  • Oropharyngeal Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neck
  • Middle Aged