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

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2018-06, Vol.30 (6), p.366-374
• Main Authors: Meade, S., Gaunt, P., Hartley, A., Robinson, M., Harrop, V., Cashmore, J., Wagstaff, L., Babrah, J., Bowden, S.J., Mehanna, H., Sanghera, P.
• Format: Article
• Language: English
• Subjects: Accelerated hypofractionation; Chemoradiotherapy - methods; Feasibility Studies; Female; human papilloma virus; Humans; Male; Middle Aged; oropharyngeal cancer; Oropharyngeal Neoplasms - etiology; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - radiotherapy; Papillomaviridae - pathogenicity; Prognosis; Prospective Studies; smoking
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2018.01.015

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