Reducing RT toxicity in head and neck cancer: recent research context
Source: www.medpagetoday.com Author: Kristin Jenkins, contributing writer, MedPage Today In patients with head and neck malignancies, studies show that the significant acute and long-term toxicities and poor quality of life (QOL) associated with postoperative radiation therapy (PORT) can be improved by selectively reducing larger radiotherapy volumes. This includes treating just one side of the neck. In patients with locally advanced head and neck squamous cell carcinoma (HNSCC), however, locoregional failure rates with the omission of PORT to the pathologically uninvolved neck (PN0) have been less clear. As a result, PORT has historically been delivered to the PN0 neck, with several studies showing high rates of regional control ranging from 95% to 100%. Notably, consensus clinical practice guidelines continue to recommend the use of bilateral irradiation of node-negative necks. However, results from a prospective phase II study in 72 patients with primary HNSCC and high-risk pathology features now suggest that PORT to the PNo neck can be eliminated without sacrificing excellent disease control or QOL. At a median follow-up of 53 months, absolute regional control in the unirradiated neck was 97%, even though 67 patients (93%) had stage III/IV disease and 71% of tumors involved or crossed midline. No patient received contralateral neck PORT, and 17 patients (24%) were treated for the primary neck tumor only, said Wade Thorstad, MD, of Washington University in St. Louis, and colleagues. The 5-year rates of local control, regional control, progression-free survival, and overall survival (OS) were 84%, 93%, 60%, and 64%, respectively, they reported [...]