Favorable Outcomes, Improved QOL Seen With Radiotherapy De-Escalation in HPV-Associated Oropharyngeal Carcinoma


Patients with human papillomavirus–associated oropharyngeal carcinoma who were given de-escalated doses of radiotherapy saw a better quality of life and favorable outcomes.

Improved quality of life and favorable clinical outcomes were observed when using a de-escalation strategy of elective radiotherapy for patients with human papillomavirus–associated oropharyngeal carcinoma treated with definitive chemoradiotherapy, according to a study published in JAMA Oncology.

Over a follow-up of 26 months, 8 patients had locoregional recurrence, 7 of whom had primary site or gross nodes received 70 Gy of radiotherapy. Additionally, 1 patient had a persistent node that had not been previously identified and received 30 Gy. At 24 months, the locoregional control rate was 97.0%, progression-free survival was 88.0%, distant metastasis-free survival was 95.2%, and overall survival was 95.1%.

A total of 276 patients enrolled with a median age of 61 years. Additionally, 89.5% of patients were men, and 90.9% were White. Additionally, 135 patients were never smokers, and 183 had a history of smoking of less than 10 years. In terms of disease distribution included 87 patients with cT3 to cT4, and 65 with cN2 to cN3 disease. The most common primary site disease was the base of the tongue or tonsil (n = 259).

Patients received a radiation dose of 30 Gy for elective and subclinical regions and cone down to 70 Gy for gross disease. A total of 87 patients received 50 Gy of radiotherapy for indeterminate nodes or areas immediately adjacent to the gross disease.

A single patient with locoregional recurrence developed synchronous distant recurrence. Additionally, 5 patients had head and neck–only recurrence, and underwent successful salvage treatment via neck dissection; these patients were alive and without evidence of disease at the last follow up. Beyond this, those receiving a dose of 30 Gy had no evidence of recurrence in the subclinical field or in the omitted elective nodal regions, and 19 patients had distant-only recurrence.

Of all the factors included in the Cox proportional hazard model, only advanced N category was associated with worse locoregional control (HR, 3.4; 95% CI, 1.1-10.6; P = .03). No differences in locoregional recurrence were observed among patients who received either high-dose cisplatin, weekly cisplatin, or chemotherapy (HR, 0.8; 95% CI, 0.2-3.5; P .71).

In terms of toxic effects, 17 patients required a feeding tube for a median of 5 months, and 4 patients had a feeding tube until death; 2 of these patients experienced locoregional disease recurrence within 6 months with the feeding tube still in place, 1 patient died from treatment complications, and 1 died from an unknown cause. In the cohort, no feeding tube was placed prophylactically.

From baseline to 3 to 6 months, domain scores worsened, and at 24 months facial pain scores had increased from a mean score of 7 (95% CI, 5-9) at baseline to a mean score of 12 (95% CI, 10-14) at 3 to 6 months. Nearly all scores were comparable to baseline with the exception of muscular tension scores, which included a mean baseline score of 13 (95% CI, 10-16) compared with 9 (95% CI, 7-11) at 3 to 6 months.


Tsai CJ, McBride SM, Riaz N, et al. Evaluation of substantial reduction in elective radiotherapy dose and field in patients with human papillomavirus-associated oropharyngeal carcinoma treated with definitive chemoradiotherapy. Published Online January 20, 2022. JAMA Oncol. doi:10.1001/jamaoncol.2021.6416

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