Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution

Radiation Oncology

Tricia Chinnery¹  Nancy Read²  Varagur Venkatesan²  Lucas C. Mendez²  Sara Kuruvilla²  Pencilla Lang²  Sylvia Mitchell²  Sarah A. Mattonen³  John W. Barrett⁴  Hugh Andrew Jinwook Kim⁴  Eric J. Di Gravio⁴  Neil Mundi⁴  Adrian Mendez⁵  John Yoo⁵  Eric Winquist⁵  S. Danielle MacNeil⁵  Kevin Fung⁵  Joe S. Mymryk⁶  David A. Palma⁷  Anthony C. Nichols⁷ 

[1]Department of Medical Biophysics, Western University, London, ON, Canada

[2]Department of Oncology, Western University, London, ON, Canada

[3]Department of Oncology, Western University, London, ON, Canada

[4]Department of Medical Biophysics, Western University, London, ON, Canada

[5]Department of Otolaryngology – Head and Neck Surgery, Western University, London, ON, Canada

[6]Department of Otolaryngology – Head and Neck Surgery, Western University, London, ON, Canada

[7]Department of Oncology, Western University, London, ON, Canada

[8]Department of Otolaryngology – Head and Neck Surgery, Western University, London, ON, Canada

[9]Department of Oncology, Western University, London, ON, Canada

[10]Department of Microbiology and Immunology, Western University, London, ON, Canada

[11]Department of Otolaryngology – Head and Neck Surgery, Western University, London, ON, Canada

[12]Department of Oncology, Western University, London, ON, Canada

[13]Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, London Health Science Centre, 800 Commissioners Road East, N6A 5W9, London, ON, Canada

关键词: Radiation;    Chemoradiation;    Oropharyngeal cancer;    Toxicity;   

DOI  :  10.1186/s13014-020-01705-1

来源: Springer

【 摘 要 】

BackgroundTransoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT.MethodsConsecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria.ResultsA total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026).ConclusionsPrimary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

【 授权许可】

CC BY