About My Health Careers Internship MedBlogs Contact us
Medindia LOGIN REGISTER
Advertisement

Low Doses of Radiation After Chemo Helps Cure HPV+ Head & Neck Cancer

by Julia Samuel on February 14, 2018 at 2:17 PM
Font : A-A+

Low Doses of Radiation After Chemo Helps Cure HPV+ Head & Neck Cancer

Lower radiation doses are safe and effective for patients with head and neck cancers associated with the human papillomavirus (HPV).

If they respond to induction chemotherapy initially, lower doses of radiation would work in treating the cancers.

Advertisement


Patients who responded well to induction chemotherapy and subsequently received the lower-dose treatment experienced excellent survival--92 percent were without evidence of recurrence two years after treatment--and had improved functional outcomes with fewer side effects, compared to those who received standard chemoradiation therapy.

Compared with HPV, negative head and neck cancer, which typically is caused by smoking and alcohol consumption, HPV-positive disease is more responsive to radiation therapy and chemotherapy and is associated with significantly higher cure rates.
Advertisement

"Head and neck tumors that are caused by HPV respond well to therapy and can be cured reliably," said Tanguy Seiwert, MD, lead author of the study and an assistant professor of medicine at the University of Chicago Medicine.

"In fact, the effectiveness of combined treatment with radiation and chemotherapy has been so well documented that newer studies such as OPTIMA are focused on selecting patients who can safely receive less treatment."

Although reducing the intensity of cancer treatment offers patients potentially better quality of life, clinicians are careful to use this approach only for patients with a favorable biology for lower-dose therapy. The OPTIMA trial examined the response to induction chemotherapy--which is systemic therapy given prior to radiation therapy--as a method to select patients likely to benefit from reduced treatment.

"With our approach of using induction chemotherapy to identify candidates for de-escalated radiation therapy, we achieved excellent treatment outcomes with giving 30 to 35 percent smaller radiation doses, even for patients with advanced nodal stages such as N2C. Patients experienced less toxicity and survival rates exceeded historic data, although more follow-up is needed to confirm these findings," said Dr. Seiwert.

"This degree of de-escalation with high-risk patients is novel, as is selection using induction as the key component to reducing radiation doses and subsequent toxicities to such low levels. In my opinion, treatment for HPV-positive disease should be de-escalated when possible, and induction is an ideal method to identify HPV-related head and neck cancer biology."

Sixty-two patients with HPV-related head and neck cancers were enrolled in OPTIMA. Patients were classified as either low-risk (?T3, ?N2B, ?10 pack-year smoking history) (45% of patients) or high-risk (T4 or ?N2C or >10 pack-years) (55%). The median patient age was 57 years (range 31-85 years), and most patients (85%) were male.

All patients in the trial received three cycles of induction chemotherapy consisting of carboplatin and nab-paclitaxel, and those who responded well received one of two de-escalated treatment regimens: 50 Gray (Gy) of radiation therapy alone (RT50 arm) for low-risk disease, or 45Gy of chemoradiation therapy (CRT45 arm) for high-risk disease.

Favorable response to induction chemotherapy was defined as 50 percent or greater reduction in tumor size for high-risk patients and 30 percent or greater reduction for low-risk patients. Patients without a favorable response received regular-dose chemoradiation therapy to 75 Gy.

Radiation therapy was delivered over five weeks of 2 Gy daily fractions on the RT50 arm. On the CRT45 and CRT75 arms, treatment consisted of paclitaxel, 5-fluorouracil and hydroxyurea systemic therapy with 1.5 Gy twice-daily radiation every other week. Median follow-up for the study was 22.3 months (range 9-39 months).

All low-risk patients and 32 of the 34 (94%) of the high-risk patients were progression-free at two years following treatment. Two-year overall survival rates were 100 percent for low-risk patients and 97 percent for high-risk patients. One high-risk patient on the CRT45 arm experienced a local recurrence at 11 months following treatment, but the recurrence was treated with salvage surgery.

Side effects from de-escalated therapy were significantly improved compared to standard treatment. Rates of grade 3 or higher mucositis were 16 percent for RT50, 46 percent for CRT45 and 60 percent for CRT75 (p = 0.033).

No RT50 patients experienced grade three or higher dermatitis, and the rates were 21 percent for CRT45 and 30 percent for CRT75 (p = 0.056). No RT50 patients experienced long-term dependency on a feeding tube, and the rates were 3.5 percent for CRT45 and 9 percent for CRT75 (p < 0.0001).

Source: Eurekalert
Advertisement

Advertisement
News A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
News Category
What's New on Medindia
Ways to Manage Stress during COVID-19 Pandemic
Can Adjusting Fatty Acid Intake Improve Mood in Bipolar Disorder Patients?
Insulin Resistance Doubles the Risk of Major Depressive Disorder
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Radiotherapy X-Ray Cancer and Homeopathy Cancer Facts Cancer Tattoos A Body Art Radiation Hazards Acute Radiation Syndrome Common Lifestyle Habits that Cause Diseases Health Benefits of Dandelion Plant 

Recommended Reading
Head and Neck Cancers
Head and neck cancers usually occur in the squamous cells lining the moist, mucosal surfaces inside ...
HPV Antibodies Signal Better Prognosis for Head and Neck Cancer Patients
The presence of HPV antibodies in head and neck cancer patients is a good prognostic marker that ......
Head and Neck Cancers Could be Treated by Targeting T Cell Channel
Regulating the expression of at the cellular level and using the body's own immune response to ......
Death Rates in Head and Neck Cancer Reduced by Twice-Daily Radiation Therapy
Twice-daily radiation therapy combined with chemotherapy to treat head and neck cancer, could save ....
Acute Radiation Syndrome
Acute radiation syndrome occurs when a person is exposed to a high dose of external penetrating radi...
Common Lifestyle Habits that Cause Diseases
Cigarette smoking, unhealthy diets, overuse of alcohol, and physical inactivity are some of the most...
Health Benefits of Dandelion Plant
What is dandelion? Dandelion greens are nutrition powerhouses with a wide range of health benefits. ...
Radiation Hazards
Ionizing radiation can damage living tissue in the human body. It strips away electrons from atoms b...
Radiotherapy
A detailed account of radiation, its mode of action, side effects and dosage in the treatment of ......
Tattoos A Body Art
Tattoos are a rage among college students who sport it for the ‘cool dude’ or ‘cool babe’ look...
X-Ray
Encyclopedia section of medindia gives a brief Overview of X-Ray  ...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use