Patients being treated for HPV-related oropharynx cancer might need less radiation therapy than typically given post-surgery, according to a new study. Less than the standard doses of post-operative radiation therapy is safe and effective and reduces side effects, researchers say, resulting in very high survival rates —marking a significant advancement in head and neck cancer care.
The results follow an E3311 trial of the ECOG-ACRIN Cancer Research Group, a membership-based scientific organization, that tested the feasibility of transoral surgery that was followed by fewer weeks of radiation than are standard of care. For example, patients classified at surgery as having intermediate risk cancers, had five weeks of post-operative radiation instead of six. Each patient in the multi-institutional trial was classified at surgery as having low, intermediate or high-risk disease. For each group, post-operative treatment was scaled back.
“Long-term follow up now demonstrates remarkable progression-free and overall survivals of 90.6% and 95.3% for the overall group,” said the study’s first author, Barbara Burtness, MD, chief of head and neck cancers/sarcoma and chief translational research officer at Yale Cancer Center. “Survival at 54 months was greater than 97% for favorable and intermediate risk groups, there was no disadvantage from treatment deintensification, and no increased risk for smokers or those with base of tongue cancers. These findings support the use of transoral surgery and reduced intensity of post-operative management.”
The findings from the 359 patients were consistent across all disease subsites and regardless of the patient's smoking history. However, having a history of smoking can result in higher recurrence rates when patients are treated with chemotherapy and radiation instead of surgery.
Burtness, who is also the Anthony N. Brady Professor of Medicine (Medical Oncology) at Yale School of Medicine, will present the study’s findings during a Clinical Sciences Symposium Session at the 2024 American Society of Clinical Oncology (ASCO) annual meeting. Robert Ferris from UPMC Hillman Cancer Center was the study’s senior author. Other authors include Yael Flamand, Harry Quon, Gregory Weinstein, Ranee Mehra, Joaquin Garcia, Seungwon Kim, Bert O'Malley, Enver Ozer, Wayne Koch, Neil Gross, Richard Bell, Mihir Patel, Miriam Lango, Luc Morris, Russell Smith, Daniel Karakla, Jeremy Richmon, and Floyd Holsinger.
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