In a recent article published Medscape, people that are HPV positive oropharyngeal cancer patients who have proven to be sensitive to induction chemotherapy now have other options- a lower, less-toxic dose of radiation therapy, according to phase 2 ECOG 1308 study. As stated by Dr. Anthony Cmelak, a professor of radiation oncology at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, the lower dose the of this “chemoselection” process is able to guide radiotherapy treatment decisions to allow fewer acute and late toxicities. It is also said that the lower dose of the radiation therapy gives the patients the ability to avoid long-term dysphagia, fibrosis, xerostomia, dental problems, strictures, and long term percutaneous endoscopic gastrostomy tubes. Dr. Cmelak goes on to explain, “the risks of these types of complications escalate rapidly after 54 Gy of intensity- modulated radiation therapy (IMRT), and become the most commonly seen long term problems in patients treated to the standard dose of 70 Gy.” This study involved 90 patients with stage III/IV HPV- positive oropharyngeal squamous carcinoma and was presented in 2014 at the annual meeting of the American Society of Clinical Oncology. These patients received induction chemotherapy with paclitaxel, cisplatin, and cetuximab. After 2 years of chemotherapy, the overall survival rate of the patients was better in the low-dose group than it was in the standard group, a comparison of 93% to 87% survival rate.
However, even though the results are in favor of the low dose radiation, it is too soon to tell if the treatment should be adopted into clinical practice. There is still a lot of discussion on whether or not patients with head and neck cancers should have reduced, low-dose radiation therapy, especially patients who are HPV-positive. Dr. Cmelak adds that he “doesn’t recommend using lower doses of radiation,” this could lead to undertreatment.
At the end of the day, it will take a large trial with many different types of patients to determine whether or not the survival rate will be affected negatively. There is no point in jeopardizing the survival rate of patients in order to reduce the toxicity rate of the treatment that is intended to help them.
This article is based off of this article.