Elsevier

Clinical Oncology

Volume 30, Issue 6, June 2018, Pages 366-374
Clinical Oncology

Original Article
Feasibility of Dose-escalated Hypofractionated Chemoradiation in Human Papilloma Virus-negative or Smoking-associated Oropharyngeal Cancer

https://doi.org/10.1016/j.clon.2018.01.015Get rights and content

Highlights

  • Feasibility study of the use of hypofractionated chemoradiotherapy in high-risk oropharyngeal cancer.

  • Study findings confirm tolerability of treatment.

  • Patient selection based on biological status of patient.

  • Forms an investigational arm of the CompARE study.

Abstract

Aims

Oropharyngeal squamous cell carcinoma (OPSCC) can be divided into favourable and poor prognostic groups by association with human papilloma virus (HPV) and smoking. This study prospectively investigated a dose-intensified schedule in poor/intermediate prognosis OPSCC.

Materials and methods

Patients with p16/HPV-negative or p16-positive N2b OPSCC with a greater than 10 pack-year smoking history were eligible. Patients were planned to receive 64 Gy in 25 fractions with cisplatin. The primary end point was absence of grade 3 mucositis at 3 months.

Results

Fifteen patients were recruited over 14 months. All patients completed a minimum of 2 years of follow-up. All patients completed full-dose radiotherapy within a median treatment time of 32 days (31–35). Grade 3 mucositis was absent in all patients at 3 months. There was one grade 4 toxicity event due to cisplatin (hypokalaemia). Complete response rates at 3 months were 100% and 93% for local disease and lymph nodes, respectively. One patient developed metastatic disease and subsequently died. Overall survival at 2 years was 93% (95% confidence interval 61–99%).

Conclusions

The schedule of 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with poor and intermediate prognosis OPSCC.

Key words

Accelerated hypofractionation
human papilloma virus
oropharyngeal cancer
smoking

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