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Author links open overlay panelDavid J.SherMD, MPH1Nhat-LongPhamMD, PhD1Jennifer L.ShahMD1NeilayanSenMD2Kimberly A.WilliamsMPH1Rathan M.SubramaniamMD, PhD3WilliamMooreMD3ReginaChorleyNP1ChulAhnPhD4Saad M.KhanMD5
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Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
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Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
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Department of Radiology, UT Southwestern Medical Center, Dallas, TX
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Department Clinical Sciences, UT Southwestern Medical Center, Dallas, TX
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Department of Medical Oncology, UT Southwestern Medical Center, Dallas, TX
Received 16 June 2020, Revised 13 August 2020, Accepted 1 September 2020, Available online 27 October 2020.
https://doi.org/10.1016/j.ijrobp.2020.09.063Get rights and content
Abstract
Purpose
The required elective nodal dose and volumes for head and neck intensity-modulated radiotherapy (IMRT) have largely been extrapolated from conventional radiotherapy fields. In this prospective, dual-center, phase II study, we investigated the efficacy and tolerability of reduced elective nodal volume and dose in oropharyngeal and laryngeal squamous cell carcinoma (SqCC).
Materials/Methods
Patients with newly-diagnosed SqCC 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 (PROs).
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 chemoradiotherapy. 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, five of which were in-field and two were elective with synchronous in-field recurrence. PRO assessment at 1 year showed superior or equivalent outcomes to baseline except for saliva and taste measures.
Conclusion
The results of this trial suggest that elective dose and volume reduction is oncologically sound for oropharyngeal and laryngeal cancer treated with IMRT, with promising quality-of-life outcomes.
Data sharing: Research data are not available at this time.
Statistical analysis: Chul Ahn, PhD and David J. Sher, MD, MPH
Research funding: None
Prior presentation: ASTRO 2019 National Meeting
Conflict of Interest statement: None
Current institutional affiliations:
Pham: Community Cancer Institute, Clovis, CA
Shah: Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI
Sen: Harold Alfond Center for Cancer Care, Augusta, ME
Subramaniam: Dean's Office, Otago Medical School, The University of Otago, Dunedin, New Zealand
Khan: Division of Oncology, Stanford University Medical Center, Palo Alto, CA
© 2020 Elsevier Inc. All rights reserved.
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