Phase II Evaluation of Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus-Associated Oropharynx Squamous Cell Carcinoma

被引：177

作者：

Ma, Daniel J. ^{[1
]}

Price, Katharine A. ^{[1
]}

Moore, Eric J. ^{[1
]}

Patel, Samir H. ^{[2
]}

Hinni, Michael L. ^{[2
]}

Garcia, Joaquin J. ^{[1
]}

Graner, Darlene E. ^{[1
]}

Foster, Nathan R. ^{[1
]}

Ginos, Brenda ^{[1
]}

Neben-Wittich, Michelle ^{[1
]}

Garces, Yolanda I. ^{[1
]}

Chintakuntlawar, Ashish V. ^{[1
]}

Price, Daniel L. ^{[1
]}

Olsen, Kerry D. ^{[1
]}

Van Abel, Kathryn M. ^{[1
]}

Kasperbauer, Jan L. ^{[1
]}

Janus, Jeffrey R. ^{[1
]}

Waddle, Mark ^{[3
]}

Miller, Robert ^{[3
]}

Shiraishi, Satomi ^{[1
]}

Foote, Robert L. ^{[1
]}

机构：

[1] Mayo Clin, Rochester, MN USA

[2] Mayo Clin, Phoenix, AZ USA

[3] Mayo Clin, Jacksonville, FL 32224 USA

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2019年 / 37卷 / 22期

基金：

美国国家卫生研究院;

关键词：

TRANSORAL ROBOTIC SURGERY; LOCALLY ADVANCED HEAD; RADIATION-THERAPY; POSITIVE HEAD; RADIOTHERAPY; CANCER; CHEMOTHERAPY; SURVIVAL; ONCOLOGY; SENSITIVITY;

D O I：

10.1200/JCO.19.00463

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSEThe purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL).PATIENTS AND METHODSMC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m(2) docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL.RESULTSAccrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement.CONCLUSIONAggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.

引用

页码：1909 / +

页数：12

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