Journal article
Practice patterns and outcomes following radiation dose de‐escalation for oropharyngeal cancer
The Laryngoscope, v 130(4), pp E171-E176
Apr 2020
PMID: 31120601
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objectives/Hypothesis
Numerous trials are evaluating radiotherapy (RT) de‐escalation for human papillomavirus (HPV)‐mediated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Herein, we evaluated the degree to which de‐escalated RT is delivered in the United States, as well as comparative outcomes with full‐dose RT as stratified for HPV status.
Study Design
Retrospective database review.
Methods
We identified patients diagnosed with OPSCC in the National Cancer Database, excluding those with stage I/II disease, unknown HPV status, receiving surgery or not receiving external beam radiation therapy to the primary site, receipt of radiation doses >75 or <54 Gy, radiation treatment course duration <25 or >75 days, and unknown or inadequate (<2 months) follow‐up. Multivariable logistic regression analysis identified variables associated with delivery of de‐escalated RT (<66 Gy). Overall survival of HPV+ and non–HPV‐mediated (HPV−) disease was compared between full‐dose and de‐escalated approaches.
Results
Altogether, 617 and 551 patients were HPV+ and HPV−, respectively. De‐escalated RT was delivered in 16.9% HPV+ and 15.2% of HPV− disease, respectively. Older patients and omission of systemic therapy were more likely to receive de‐escalated RT. In HPV+ patients, 3‐ and 5‐year survival rates were 83% and 80% in the de‐escalated cohort versus 83% and 78% in the full‐dose group (
P
= .83). In HPV− patients, corresponding 3‐ and 5‐year survival rates were 29% and 23% versus 61% and 51% (
P
= .001).
Conclusions
National utilization of de‐escalated RT for OPSCC is low (15%–20%), but does not seem to impact overall survival in HPV+ (but not HPV−) patients. The caveats of this heterogeneous, retrospective analysis require corroboration from a number of ongoing randomized trials.
Level of Evidence
2c
Laryngoscope
, 130:E171–E176, 2020
Metrics
Details
- Title
- Practice patterns and outcomes following radiation dose de‐escalation for oropharyngeal cancer
- Creators
- Richard White - Allegheny Health NetworkStephen Abel - Allegheny Health NetworkShaakir Hasan - Allegheny Health NetworkVivek Verma - Allegheny Health NetworkLarisa Greenberg - Allegheny Health NetworkAthanasios Colonias - Allegheny Health NetworkRodney E. Wegner - Allegheny Health Network
- Publication Details
- The Laryngoscope, v 130(4), pp E171-E176
- Publisher
- Wiley
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000521124400009
- Scopus ID
- 2-s2.0-85066904590
- Other Identifier
- 991021930836304721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Medicine, Research & Experimental
- Otorhinolaryngology