Shorter Radiation Course Shows Promise for Reducing Long-Term side Effects in HPV-Related throat Cancer Patients
Rochester, MN – A new clinical trial demonstrates that a reduced dose of radiation therapy, combined with chemotherapy, is better tolerated by patients undergoing treatment following surgery for oropharyngeal cancer linked to the human papillomavirus (HPV) without sacrificing treatment effectiveness. The findings, published in the September issue of the Lancet Oncology, offer a potential path toward considerably improving the quality of life for individuals battling this increasingly common cancer.
Oropharyngeal cancer, affecting the back of the throat, tonsils, and base of the tongue, has seen rising incidence rates in recent decades, largely driven by the spread of HPV. Standard treatment typically involves high doses of radiation alongside chemotherapy, frequently enough leading to debilitating long-term side effects like difficulty swallowing, esophageal inflammation, and hearing loss. This new research suggests a less intensive approach can minimize these burdens. The phase 3 trial, led by Dr. Daniel Ma of the Mayo clinic, enrolled 194 adults with stage III to stage IV HPV-associated oropharyngeal squamous cell carcinoma who had undergone surgery and demonstrated high levels of p16 protein expression in their tumor samples – a marker indicating HPV involvement.
Patients were randomly assigned to either a deescalated radiotherapy regimen (30 to 36 Gy in 1.5 to 1.8 Gy fractions twice daily for two weeks, plus docetaxel chemotherapy) or the standard of care (60 Gy in 2 Gy fractions daily for six weeks, plus cisplatin chemotherapy). Results showed a significantly lower rate of cumulative chronic grade 3 or higher toxicity – 3% in the deescalated group versus 11% in the standard care group – observed between three and 24 months post-treatment. Rates of needing a feeding tube (percutaneous endoscopic gastrostomy) were also lower with the deescalated approach (2% vs.8%). The moast common severe side effects in the deescalated group were dysphagia (difficulty swallowing), esophagitis, and hearing impairment.
“We’ve significantly reduced the burden of long-term side effects without compromising the effectiveness of the treatment,” Dr. Ma stated. The study authors note that these findings could lead to updated treatment guidelines,offering a more patient-centered approach to managing HPV-related oropharyngeal cancer. Further follow-up is planned to assess long-term cancer control outcomes. Several authors disclosed financial ties to the biopharmaceutical and publishing industries.
