Loading ...

TOPLINE:

In definitive radiotherapy, reducing the elective dose from 50 Gy to 43 Gy was safe and did not significantly increase the risk for recurrence in electively irradiated lymph nodes among patients with oropharyngeal, laryngeal, or hypopharyngeal squamous cell carcinoma.

METHODOLOGY:

• Definitive radiotherapy is the standard treatment for head and neck squamous cell carcinoma, but it often leads to significant long-term side effects, particularly from elective neck irradiation. Researchers aimed to determine whether a lower dose of radiation could maintain efficacy while minimizing adverse effects.
• They analyzed 295 patients with newly diagnosed stage cT2-4N0-2M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who were randomly assigned in a 2:1 ratio to receive definitive accelerated radiotherapy alone with either a reduced elective dose (43 Gy; dose-reduction group) or a standard dose (50 Gy; control group).
• The treatment protocol involved using external beam radiotherapy with intensity modulation and simultaneous integrated boost, delivering 68 Gy in 34 fractions over 5.5 weeks to the primary tumor. The dose fractionation scheme used in the first 38 participants was 66 Gy in 33 fractions delivered in 5 weeks.
• The primary outcome was the normalcy of the diet score of the clinician-rated Performance Status Scale for Head and Neck at 1 year, whereas the secondary outcome was recurrence in electively irradiated lymph nodes at 2 years in the dose-reduction group. The median follow-up duration was 24.5 months.

TAKEAWAY:

• The mean normalcy of the diet score at 1 year was 91.6 in the dose-reduction group and 92.6 in the control group, with no significant between-group difference (mean difference, −1.1; 95% CI, −6.5 to 4.4).
• Recurrence rates in electively irradiated lymph nodes at 2 years were comparable between groups (4.9% in the dose-reduction group and 4.3% in the control group; hazard ratio, 1.11). The upper-bound one-sided 95% CI of the dose-reduction group did not exceed the prespecified boundary for acceptability (9%), confirming that the reduced dose was safe.
• Acute dysphagia of grade 3 or higher occurred less frequently in the dose-reduction group than in the control group (relative risk [RR], 0.56; P = .046).
• Regarding quality-of-life measures, dry mouth symptoms alleviated at 3 months posttreatment in the dose-reduction group, with 46% of patients reporting moderate to severe symptoms compared with 60% of those in the control group (RR, 0.76; 95% CI, 0.60-0.97; P = .025).

IN PRACTICE:

“This is the second randomized trial demonstrating that reduced elective dose is safe in definitive [radiotherapy] for oropharyngeal, laryngeal, and hypopharyngeal [squamous cell carcinoma],” the authors wrote.

SOURCE:

This study, led by Sven van den Bosch, MD, PhD, Radboud University Medical Center in Nijmegen, the Netherlands, was published online in Journal of Clinical Oncology.

LIMITATIONS:

The majority of participants had an unrestricted full diet at 1- and 2-year follow-up, which left minimal room for demonstrating improvement in the normalcy of diet scores. Additionally, the results were not directly applicable to patients receiving the standard 7-week course of chemoradiation as this was a radiotherapy-only study.

DISCLOSURES:

The study received support through a grant from the Dutch Cancer Society. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.