Radiation Therapy for HPV-Positive Oropharyngeal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline.

Autor:	Margalit DN; Department of Radiation Oncology, Brigham & Women's/Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts. Electronic address: Danielle_Margalit@dfci.harvard.edu., Anker CJ; Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont., Aristophanous M; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York., Awan M; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin., Bajaj GK; Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia., Bradfield L; American Society for Radiation Oncology, Arlington, Virginia., Califano J; Department of Surgery, University of California San Diego Health, San Diego, California., Caudell JJ; Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida., Chapman CH; Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas., Garden AS; Department of Radiation Oncology, University of Texas - MD Anderson Cancer Center, Houston, Texas., Harari PM; Department of Human Oncology, University of Wisconsin, Madison, Wisconsin., Helms A; American Society for Radiation Oncology, Arlington, Virginia., Lin A; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania., Maghami E; Department of Surgery, City of Hope, Duarte, California., Mehra R; Department of Medical Oncology, University of Maryland Medical School and Greenebaum Comprehensive Cancer Center, Baltimore, Maryland., Parker L; Patient representative, Roswell, Georgia., Shnayder Y; Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas., Spencer S; Department of Radiation Oncology, University of Alabama Heersink School of Medicine, Birmingham, Alabama., Swiecicki PL; Department of Medical Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan., Tsai JC; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada., Sher DJ; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2024 Sep-Oct; Vol. 14 (5), pp. 398-425. Date of Electronic Publication: 2024 Jun 18.
DOI:	10.1016/j.prro.2024.05.007
Abstrakt:	Purpose: Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct disease from other head and neck tumors. This guideline provides evidence-based recommendations on the critical decisions in its curative treatment, including both definitive and postoperative radiation therapy (RT) management. Methods: ASTRO convened a task force to address 5 key questions on the use of RT for management of HPV-associated OPSCC. These questions included indications for definitive and postoperative RT and chemoradiation; dose-fractionation regimens and treatment volumes; preferred RT techniques and normal tissue considerations; and posttreatment management decisions. The task force did not address indications for primary surgery versus RT. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. Results: Concurrent cisplatin is recommended for patients receiving definitive RT with T3-4 disease and/or 1 node >3 cm, or multiple nodes. For similar patients who are ineligible for cisplatin, concurrent cetuximab, carboplatin/5-fluorouracil, or taxane-based systemic therapy are conditionally recommended. In the postoperative setting, RT with concurrent cisplatin (either schedule) is recommended for positive surgical margins or extranodal extension. Postoperative RT alone is recommended for pT3-4 disease, >2 nodes, or a single node >3 cm. Observation is conditionally recommended for pT1-2 disease and a single node ≤3 cm without other risk factors. For patients treated with definitive RT with concurrent systemic therapy, 7000 cGy in 33 to 35 fractions is recommended, and for patients receiving postoperative RT without positive surgical margins and extranodal extension, 5600 to 6000 cGy is recommended. For all patients receiving RT, intensity modulated RT over 3-dimensional techniques with reduction in dose to critical organs at risk (including salivary and swallowing structures) is recommended. Reassessment with positron emission tomography-computed tomography is recommended approximately 3 months after definitive RT/chemoradiation, and neck dissection is recommended for convincing evidence of residual disease; for equivocal positron emission tomography-computed tomography findings, either neck dissection or repeat imaging is recommended. Conclusions: The role and practice of RT continues to evolve for HPV-associated OPSCC, and these guidelines inform best clinical practice based on the available evidence. (Copyright © 2024 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu