Prashant Vempati1,2, Aditya N Halthore1,2, Sewit Teckie1,2, Zaker Rana1,2, Emile Gogineni1,2, Jeffrey Antone1, Honglai Zhang1, Mihaela Marrero1, Kristin Beadle2, Douglas K Frank2,3, Mohamed Aziz2, Doru Paul2,4, Maged Ghaly5,6. 1. Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA. 2. Hofstra Northwell School of Medicine, Hempstead, NY, USA. 3. Department of Otolaryngology, Northwell Health, Lake Success, NY, USA. 4. Department of Hematology/Oncology, Northwell Health, Lake Success, NY, USA. 5. Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA. Mghaly@northwell.edu. 6. Hofstra Northwell School of Medicine, Hempstead, NY, USA. Mghaly@northwell.edu.
Abstract
BACKGROUND AND PURPOSE: Patients with locally advanced oropharynx squamous cell carcinoma have suboptimal outcomes with standard chemoradiation. Here, we evaluated toxicity and oncologic outcomes of dose escalation using radiosurgical boost for patients with unfavorable oropharynx squamous cell carcinoma. MATERIALS AND METHODS: Between 2010-2017, Thirty four patients with intermediate- or high-risk oropharynx squamous cell carcinoma were enrolled onto this prospective phase I trial. Each patient received concurrent cisplatin and fractionated radiotherapy totaling 60 Gy or 66 Gy followed by radiosurgery boost to areas of residual gross tumor: single fraction of 8 Gy or 10 Gy, or two fractions of 5 Gy each. Primary endpoint was treatment toxicity. Secondary endpoints were local, regional, and distant disease control. RESULTS: Eleven, sixteen and seven patients received radiosurgery boost with 8 Gy in 1 fraction, 10 Gy in 1 fraction, and 10 Gy in 2 fractions respectively. Acute toxicities include 4 patients with tumor necrosis causing grade 3 dysphagia, of which 3 developed grade 4 pharyngeal hemorrhage requiring surgical intervention. At 24 months after treatment, 7%, 9%, and 15% had grade 2 dysgeusia, xerostomia, and dysphagia, respectively, and two patients remained feeding tube dependent. No grade 5 toxicities occurred secondary to treatment. Local, regional, and distant control at a median follow up of 4.2 years were 85.3%, 85.3% and 88.2%, respectively. Five patients died resulting in overall survival of 85.3%. CONCLUSIONS: This study is the first to report the use of radiosurgery boost dose escalation in patients with unfavorable oropharynx squamous cell carcinoma. Longer follow-up, larger cohorts, and further refinement of boost methodology are needed prior to implementation in routine clinical practice. TRIAL REGISTRATION: Northwell Health Protocol #09-309A (NCT02703493) ( https://clinicaltrials.gov/ct2/show/NCT02703493 ).
BACKGROUND AND PURPOSE:Patients with locally advanced oropharynx squamous cell carcinoma have suboptimal outcomes with standard chemoradiation. Here, we evaluated toxicity and oncologic outcomes of dose escalation using radiosurgical boost for patients with unfavorable oropharynx squamous cell carcinoma. MATERIALS AND METHODS: Between 2010-2017, Thirty four patients with intermediate- or high-risk oropharynx squamous cell carcinoma were enrolled onto this prospective phase I trial. Each patient received concurrent cisplatin and fractionated radiotherapy totaling 60 Gy or 66 Gy followed by radiosurgery boost to areas of residual gross tumor: single fraction of 8 Gy or 10 Gy, or two fractions of 5 Gy each. Primary endpoint was treatment toxicity. Secondary endpoints were local, regional, and distant disease control. RESULTS: Eleven, sixteen and seven patients received radiosurgery boost with 8 Gy in 1 fraction, 10 Gy in 1 fraction, and 10 Gy in 2 fractions respectively. Acute toxicities include 4 patients with tumor necrosis causing grade 3 dysphagia, of which 3 developed grade 4 pharyngeal hemorrhage requiring surgical intervention. At 24 months after treatment, 7%, 9%, and 15% had grade 2 dysgeusia, xerostomia, and dysphagia, respectively, and two patients remained feeding tube dependent. No grade 5 toxicities occurred secondary to treatment. Local, regional, and distant control at a median follow up of 4.2 years were 85.3%, 85.3% and 88.2%, respectively. Five patients died resulting in overall survival of 85.3%. CONCLUSIONS: This study is the first to report the use of radiosurgery boost dose escalation in patients with unfavorable oropharynx squamous cell carcinoma. Longer follow-up, larger cohorts, and further refinement of boost methodology are needed prior to implementation in routine clinical practice. TRIAL REGISTRATION: Northwell Health Protocol #09-309A (NCT02703493) ( https://clinicaltrials.gov/ct2/show/NCT02703493 ).
Authors: Hans Paul van der Laan; Miranda E M C Christianen; Hendrik P Bijl; Cornelis Schilstra; Johannes A Langendijk Journal: Radiother Oncol Date: 2011-11-21 Impact factor: 6.280
Authors: Abrahim Al-Mamgani; Lisa Tans; David N Teguh; Peter van Rooij; Ellen M Zwijnenburg; Peter C Levendag Journal: Int J Radiat Oncol Biol Phys Date: 2011-07-26 Impact factor: 7.038
Authors: Allen M Chen; Carol Felix; Pin-Chieh Wang; Sophia Hsu; Vincent Basehart; Jordan Garst; Phillip Beron; Deborah Wong; Michael H Rosove; Shyam Rao; Heather Melanson; Edward Kim; Daphne Palmer; Lihong Qi; Karen Kelly; Michael L Steinberg; Patrick A Kupelian; Megan E Daly Journal: Lancet Oncol Date: 2017-04-20 Impact factor: 41.316