Oropharynx cancers that test positive for the human papillomavirus (HPV) have been rising. After radiation treatment, these patients often experience severe, lifelong swallowing, eating, and nutritional issues. However, reducing radiation for some patients with HPV-associated oropharyngeal squamous cell carcinomas can maintain high cure rates while sparing some of these late toxicities, according to recent research.
“We found there are some patients who have very high cure rates with reduced doses of radiation,” said Barbara Burtness, MD, professor of medicine (medical oncology) at the Yale Cancer Center, disease research team leader for the Head and Neck Cancers Program at the Smilow Center, and chair of the Eastern Cooperative Oncology Group and American College of Radiology Imaging Network (ECOG-ACRIN) head and neck committee. “Radiation dose reduction resulted in significantly improved swallowing and nutritional status.”
The study showed that patients treated with reduced radiation had less difficulty swallowing solids (40% versus 89% of patients treated with standard doses of radiation) or impaired nutrition (10% versus 44% of patients treated with regular doses of radiation).
“Today, many younger patients are presenting with HPV-associated squamous cell carcinoma of the oropharynx,” said Burtness. “And while traditional chemoradiation has demonstrated good tumor control and survival rates for patients, too often they encounter unpleasant outcomes that can include difficulty swallowing solid foods, impaired nutrition, and feeding tube dependence. 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.”
The study included 80 patients from 16 ECOG-ACRIN Cancer Research Group sites who had stage 3 or 4 HPV-positive squamous cell carcinoma of the oropharynx and who were candidates for surgery. Eligible patients received 3 courses of induction chemotherapy with the drugs cisplatin, paclitaxel, and cetuximab. Patients with good clinical response then received reduced radiation. Also, patients who smoked fewer than 10 packs of cigarettes a year had very high disease control compared to heavy smokers.
The study, “E1308: Phase II Trial of Induction Chemotherapy Followed by Reduced-Dose Radiation and Weekly Cetuximab in Patients With HPV-Associated Resectable Squamous Cell Carcinoma of the Oropharynx—ECOG-ACRIN Cancer Research Group,” was published by the Journal of Clinical Oncology.