Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): Patients with locally advanced oropharynx squamous cell carcinoma have poor outcomes with standard chemoradiation therapy. Here, we evaluated toxicity and oncologic outcomes of dose escalation using radiosurgical boost for patients with unfavorable oropharynx squamous cell carcinoma.
Materials/Methods: Thirty two patients with intermediate- or high-risk oropharynx squamous cell carcinoma were enrolled onto this prospective phase I trial. Each patient received concurrent cisplatin and fractionated radiotherapy totaling 60 Gy followed by single fraction radiosurgery boost of 8 Gy or 10 Gy to areas of gross tumor. Primary endpoint was treatment safety. Secondary endpoints were local, regional, and distant disease control.
Results: Eleven and 17 patients received a radiosurgery boost with either 8 Gy and 10 Gy, respectively. In terms of the side-effects, acutely 4 patients had tumor necrosis causing grade 3 dysphagia, of which 3 developed grade 4 pharyngeal hemorrhage requiring surgical intervention. At 46 months after treatment, 7%, 9%, and 15% had grade 2 dysgeusia, xerostomia, and dysphagia, respectively, and one patient remained feeding tube dependent. No grade 5 toxicities occurred secondary to treatment. Local, regional, and distant control at 46 months were 84.9%, 87.9% and 84.9%, respectively. The overall survival 84.8%.
Conclusion: This study is the first to report the feasibility of radiosurgery boost dose escalation in patients with unfavorable oropharynx squamous cell carcinoma. Longer follow-up, larger cohorts, and further refinement of boost methodology are needed prior to implementation in routine clinical practice.
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