Top Line: Attempts to de-escalate head and neck radiation have seen many iterations over recent years.
The Study: One strategy that hasn’t been widely explored is treating gross disease only. It works for lung cancer, after all, and we’ve seen trials exploring very low dose elective nodal irradiation. This phase 2 trial enrolled 67 patients with head and neck mucosal squamous cell carcinoma of all types and boldly treated gross disease only with definitive radiation. The majority had oropharyngeal primaries (n=49) and the rest larynx/hypopharynx (n=18). The primary and gross nodal disease received 70 Gy in 35 fractions. An AI model was used to identify “suspicious” lymph nodes that received 66.5 Gy, but there was no elective nodal irradiation. At 2 years, there were no solitary recurrences within the elective nodal regions. Swallowing toxicity was low with no significant decline in MD Anderson Dysphagia Index scores. Less than a quarter of patients (21%) required feeding tube placement during treatment.
TBL: In this single arm trial, omitting coverage of elective nodal regions resulted in no isolated nodal recurrences for patients receiving definitive radiation for head and neck cancer. Larger randomized trials are necessary, though, to know whether this approach reduces toxicity without increasing the risk of disease recurrence. | Sher, Clin Can Res 2023
The Study: One strategy that hasn’t been widely explored is treating gross disease only. It works for lung cancer, after all, and we’ve seen trials exploring very low dose elective nodal irradiation. This phase 2 trial enrolled 67 patients with head and neck mucosal squamous cell carcinoma of all types and boldly treated gross disease only with definitive radiation. The majority had oropharyngeal primaries (n=49) and the rest larynx/hypopharynx (n=18). The primary and gross nodal disease received 70 Gy in 35 fractions. An AI model was used to identify “suspicious” lymph nodes that received 66.5 Gy, but there was no elective nodal irradiation. At 2 years, there were no solitary recurrences within the elective nodal regions. Swallowing toxicity was low with no significant decline in MD Anderson Dysphagia Index scores. Less than a quarter of patients (21%) required feeding tube placement during treatment.
TBL: In this single arm trial, omitting coverage of elective nodal regions resulted in no isolated nodal recurrences for patients receiving definitive radiation for head and neck cancer. Larger randomized trials are necessary, though, to know whether this approach reduces toxicity without increasing the risk of disease recurrence. | Sher, Clin Can Res 2023