Phase I trial of dose-escalated stereotactic radiosurgery (SRS) boost for unfavorable locally advanced oropharyngeal cancer

Autor: E. Gogineni, Prashant Vempati, H. Zhang, Kristin A. Beadle, Maged Ghaly, Z.H. Rana, Sewit Teckie, D. Paul, M. Marrero, Douglas Frank, Mohamed Aziz, J. Antone, Aditya Halthore
Rok vydání: 2020
Předmět:
lcsh:Medical physics. Medical radiology. Nuclear medicine
Male
medicine.medical_specialty
lcsh:R895-920
medicine.medical_treatment
Head-and-neck
Oropharynx
Radiosurgery
lcsh:RC254-282
030218 nuclear medicine & medical imaging
SRS
03 medical and health sciences
0302 clinical medicine
Median follow-up
Clinical endpoint
Medicine
Humans
Radiology
Nuclear Medicine and imaging
Prospective Studies
Feeding tube
Dose escalation
business.industry
Squamous Cell Carcinoma of Head and Neck
Radiotherapy Planning
Computer-Assisted
Research
Cancer
Radiotherapy Dosage
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
Dysphagia
Dysgeusia
Radiation therapy
Oropharyngeal Neoplasms
Oncology
030220 oncology & carcinogenesis
Female
Radiology
Radiotherapy
Intensity-Modulated
medicine.symptom
business
Zdroj: Radiation Oncology (London, England)
Radiation Oncology, Vol 15, Iss 1, Pp 1-10 (2020)
ISSN: 1748-717X
Popis: Background and purpose Patients with locally advanced oropharynx squamous cell carcinoma have suboptimal outcomes with standard chemoradiation. Here, we evaluated toxicity and oncologic outcomes of dose escalation using radiosurgical boost for patients with unfavorable oropharynx squamous cell carcinoma. Materials and methods Between 2010–2017, Thirty four patients with intermediate- or high-risk oropharynx squamous cell carcinoma were enrolled onto this prospective phase I trial. Each patient received concurrent cisplatin and fractionated radiotherapy totaling 60 Gy or 66 Gy followed by radiosurgery boost to areas of residual gross tumor: single fraction of 8 Gy or 10 Gy, or two fractions of 5 Gy each. Primary endpoint was treatment toxicity. Secondary endpoints were local, regional, and distant disease control. Results Eleven, sixteen and seven patients received radiosurgery boost with 8 Gy in 1 fraction, 10 Gy in 1 fraction, and 10 Gy in 2 fractions respectively. Acute toxicities include 4 patients with tumor necrosis causing grade 3 dysphagia, of which 3 developed grade 4 pharyngeal hemorrhage requiring surgical intervention. At 24 months after treatment, 7%, 9%, and 15% had grade 2 dysgeusia, xerostomia, and dysphagia, respectively, and two patients remained feeding tube dependent. No grade 5 toxicities occurred secondary to treatment. Local, regional, and distant control at a median follow up of 4.2 years were 85.3%, 85.3% and 88.2%, respectively. Five patients died resulting in overall survival of 85.3%. Conclusions This study is the first to report the use of radiosurgery boost dose escalation in patients with unfavorable oropharynx squamous cell carcinoma. Longer follow-up, larger cohorts, and further refinement of boost methodology are needed prior to implementation in routine clinical practice. Trial Registration: Northwell Health Protocol #09-309A (NCT02703493) (https://clinicaltrials.gov/ct2/show/NCT02703493)
Databáze: OpenAIRE
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