Functional Outcomes after De-Escalated Chemoradiation for Human Papillomavirus-Positive Oropharyngeal Cancer: Secondary Analysis of a Phase II Trial

Publication date: Available online 6 November 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): John V. Hegde, Narek Shaverdian, Carol Felix, Pin-Chieh Wang, Darlene Veruttipong, Sophia Hsu, Jonathan Riess, Shyam D. Rao, Megan E. Daly, Allen M. Chen
PurposeTo analyze functional outcomes for patients treated on a phase II trial of de-escalated chemoradiation for human papillomavirus (HPV)-positive oropharyngeal cancer.MethodsEligibility included p16-positive, stage III or IV oropharyngeal squamous cell carcinoma, and Zubrod performance status 0-1. Treatment was induction paclitaxel 175 mg/m² and carboplatin AUC 6 for 2 cycles every 21 days followed by concurrent paclitaxel 30 mg/m² every 7 days with dose-reduced radiation of 54 or 60 Gy. Trends in body weight and body mass index (BMI) were analyzed with gastrostomy tube and narcotic utilization rates. Functional outcomes were assessed using the University of Washington Quality of Life Scale and the Functional Assessment of Cancer Therapy-Head and Neck Scale.ResultsForty-five patients were registered, of whom 40 were evaluable. Only 1 patient had a BMI deemed to be unhealthy at the completion of treatment. For the 15 patients (38%) with a normal BMI (18-25 kg/m²) pre-treatment, recovery back to baseline occurred at approximately 18 months (average BMI 23.2 vs. 22.3 kg/m², respectively, p=0.09). Two patients (5%) had gastrostomy tubes placed during treatment. No patient was enteral feeding tube dependent at 6 months post-treatment. Ninety-five percent tolerated a normal regular diet at last follow-up.ConclusionsDe-escalated chemoradiation may improve functional outcomes as indicated by the relatively low incidence of gastrostomy tube placement and long-term dysphagia. In patients with a normal BMI prior to chemoradiation, BMI recovered to baseline levels.

Teaser

For patients with human papillomavirus (HPV)-associated oropharyngeal carcinoma undergoing chemoradiation with induction chemotherapy followed by de-escalated chemoradiation to 54 or 60 Gy with concurrent paclitaxel, functional outcomes, including nutritional status, gastrostomy tube use, dysphagia, and narcotic use, appear similar or favorable to historical controls treated with definitive chemoradiation to 70 Gy. These findings support ongoing efforts to evaluate de-escalated chemoradiation in patients with HPV-associated oropharyngeal carcinoma.


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