A Prospective Study of Mucosal Sparing Radiation Therapy in Resected Oropharyngeal Cancer Patients.

Autor:	Anderson JD; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona., DeWees TA; Department of Quantitative Health Sciences, Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona., Ma DJ; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Nagel TH; Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona., Van Abel KM; Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Moore EJ; Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Rwigema JCM; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona., Routman DM; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Wittich MN; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., McGee LA; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona., Hayden RE; Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona., Foote RL; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Golafshar M; Department of Quantitative Health Sciences, Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona., Gamez ME; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Lester SC; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Anand A; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona., Crujido LR; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Halyard MY; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona., Hinni ML; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Patel SH; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona. Electronic address: patel.samir@mayo.edu.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2023 Jan 01; Vol. 115 (1), pp. 192-201. Date of Electronic Publication: 2022 Oct 26.
DOI:	10.1016/j.ijrobp.2022.06.057
Abstrakt:	Purpose: Our objective was to report the prospective results of mucosal sparing radiation therapy in human papillomavirus-related oropharyngeal squamous cell carcinoma. Methods and Materials: From March 2016 through May 2019, patients were enrolled in this institutional review board-approved prospective cohort study at a multisite institution. Inclusion criteria included p16+ American Joint Committee on Cancer seventh edition pathologic T1 or T2, N1 to N3, and M0 oropharyngeal cancers. Proton therapy (PT) was delivered to at-risk nodal regions, excluding the primary mucosal site. Secondary to insurance denial for PT, intensity modulated radiation therapy (IMRT) was allowed. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module and Patient-Reported Outcomes Measurement Information System surveys (quality of life [QOL]) and modified barium swallowing impairment profiles (MBSImP) were obtained at baseline before radiation therapy, then 3 and 12 months after radiation therapy. Kaplan-Meier estimates were calculated for time-to-event clinical outcomes, and repeated measures mixed models were used to explore changes in QOL over time. A comparison of QOL and swallowing outcomes with standard-of-care treatment was analyzed. Results: There were 61 evaluable patients with a median follow-up of 38 months (range, 10-64); 44 (72%) were treated with PT and 17 (28%) were treated with IMRT. The 2-year local control, locoregional control, distant metastasis-free survival, and overall survival were 98%, 97%, 98%, and 100%, respectively. There were 6 grade ≥3 events related to treatment. Two IMRT patients required percutaneous endoscopic gastrostomy tube placement during treatment secondary to significant nausea due to dysgeusia. Patients noted significant QOL improvement over time in the pain, swallowing, speech, social eating, social contact, mouth opening, and use of pain medication domains (all P < .02). The MBSImP overall severity score as well as oral and pharyngeal impairment scores showed stability with no significant change over time. For the 44 patients treated with PT, the mean D95 to the primary target was 10.7 Gy (standard deviation = 12.5 Gy). Conclusions: Mucosal sparing radiation is well tolerated in select resected human papillomavirus-related oropharyngeal squamous cell carcinoma with a low risk of recurrence at the mucosal primary site, a low rate of percutaneous endoscopic gastrostomy tube placement, and few radiation-related grade ≥3 adverse events. (Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu