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H&N Flashcards

1
Q

Trial: RTOG 7303

What kind of trial was this?
What was the main question of this trial?

A

General H&N -> Pre-op vs Postop RT -> Advanced supraglottic larynx, hypopharynx, oropharynx, oral cavity

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2
Q

Trial: RTOG 7303

What was the patient population?

A

Advanced supraglottic larynx, hypopharynx, oropharynx, oral cavity: T2-T4, any N except N3a

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3
Q

Trial: RTOG 7303

What was this trial comparing?

A

Larynx/hypopharynx: Preop 50Gy vs. Postop 60Gy.

Oral cavity/oropharynx: Preop vs. postop vs. definitive RT

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4
Q

Trial: RTOG 7303

What were the results? Conclusions?

A

Post-op RT improved 10-yr LRC 58% vs. 70%. Severe complications similar in both arms.

Most failed in 2 years. After this, DM and second primaries were main cause of failure.

Post-operative radiation therapy improves LRC compared to post-op RT.

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5
Q

Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017

What kind of trial was this?
What was the main question of this trial?

A

General H&N -> Dose escalation -> Stage III or IV oral cavity, oropharynx, hypopharynx, larynx

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6
Q

Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017

What was the patient population?

A

Stage III or IV oral cavity, oropharynx, hypopharynx, larynx

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7
Q

Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017

What was this trial comparing?

A

Low risk: (52.2 Gy or 57.6) vs. 63 Gy (dose changed to 57.6 after excess failures seen with 52.2)
High risk: 68.4 Gy vs. 63 Gy

Patients were stratified into low and high risk groups by a point system, now not in use. Assessment was separate for head and neck. Positive margin was automatically high risk. ECE points were such that it could be in the low or high risk group. Number of nodes, margin distances, and sizes were other factors.

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8
Q

Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017

What were the results? Conclusions?

A

Final report (over 20-yr follow-up):
No difference in tumor control between dose levels in low or high risk groups
Factors impacting LRC & OS: treatment time ≥85 days, +margin, ECE
Worse OS only: age ≥57
5-yr LRC 67%, 2nd cancers 27%
5- and 10-yr FFDM 64% and 60%
5- and 10-yr OS 32% and 20%

Initial report: Those who received <54 Gy had higher failure than those getting 57.6 Gy or greater. ECE benefited with 63 Gy or above. 2-3 risk factors gave increased recurrence risk. 4 risk factors gives risk similar to ECE

Final conclusion: There is no improvement in tumor control with dose escalation from 57.6 Gy to 68.4 Gy in 1.8 Gy/fx without chemo.

COMMENTARY:
Cobalt era, 1.8 Gy/fx with no chemotherapy. Authors theorize repopulation may be occuring because of dose <2 Gy, thus escalation not successful.

Many ECE patients would have been included in “low risk” group, e.g for low # nodes or small nodes with ECE. “Low risk” and “high risk” patients determined by a now outdated point system. Head vs. neck risk determined separately.

Note the high risk group only “escalated” from 63 Gy to 68.4 Gy. Unknown if an even lower dose is appropriate for the high risk group.

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9
Q

Trial: Belgium; Radiotherapy Oncology 2016

What kind of trial was this?
What was the main question of this trial?

A

General -> Dose escalation -> Previously untreated head and neck cancer. T1-T2N0 were allowed if elective neck radiation planned

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10
Q

Trial: Belgium; Radiotherapy Oncology 2016

What was the patient population?

A

Previously untreated head and neck cancer. T1-T2N0 were allowed if elective neck radiation planned

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11
Q

Trial: Belgium; Radiotherapy Oncology 2016

What was this trial comparing?

A

Randomized. Elective nodal volume to 50 Gy vs. 40 Gy in normalized effective dose in 2 Gy fractions. 70 Gy in NID 2 Gy per fraction to primary tumor. All patients treated with IMRT

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12
Q

Trial: Belgium; Radiotherapy Oncology 2016

What were the results? Conclusions?

A

No difference in LF, estimated regional failure, estimated DM, estimated DFS, or OS
LF 14% vs. 14%, RF 13% vs. 6%, DM 13% vs. 19%, DFS 58% vs. 65%, OS 72% vs. 73%
Reduction of salivary toxicity with 40 Gy
17-19% had lymph node dissection

In this study there is no difference in recurrence or survival in 50 Gy vs 40 Gy. 40 Gy results in lower salivary toxicity.

COMMENTARY:
In the era of IMRT, many do 1.6-1.8 Gy per fraction to the low risk neck as opposed to 2.0 Gy per fraction.

Patient characteristics:
~18% had neck dissection
~25% T4, 33% T3, 33% T2, few T1
~22% N0, 16% N1, 55% N2, 3% N3

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13
Q

Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014

What kind of trial was this?
What was the main question of this trial?

A

General -> Altered fractionation -> Stage III-IV (or II for BOT/hypopharynx)

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14
Q

Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014

What was the patient population?

A

Stage III-IV (or II for BOT/hypopharynx)

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15
Q

Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014

What was this trial comparing?

A

1) Conventional 70/35 fx in 2Gy vs.
2) Hyperfx 81.6/68 fx in 7 wks in 1.2Gy BID vs.
3) Accel Split: 67.2/42 fx in 6 wks at 1.6Gy BID with 2-wk break at 38.4Gy vs.
4) Accel-con boost: 72Gy/42 fx in 6 wks at 1.8Gy and 1.5Gy
IMRT not allowed

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16
Q

Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014

What were the results? Conclusions?

A

Intial: Hyperfrac and delayed concominant boost had better LRC (54%), with trend for better DFS. OS not different.

UPDATE: Hyperfx gives increase in OS, LC when 5 year patients are censored, and decreased late effects. 97% of LR occurred within 5 years. After five years, more second cancers arose (very small amount). Severe late grade 3 to 5 toxicity trended worse for Accel regimen

Hyperfrac and accel/concom boost result im improved outcomes and lower toxicity than standard fractionation

COMMENTARY:
IMRT not allowed

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17
Q

Trial: IAEA-ACC, Overgaard Lancet 2010

What kind of trial was this?
What was the main question of this trial?

A

General -> Altered fractionation -> glottic, supraglottic pharynx, oral cavity not receiving chemo

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18
Q

Trial: IAEA-ACC, Overgaard Lancet 2010

What was the patient population?

A

glottic, supraglottic pharynx, oral cavity not receiving chemo

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19
Q

Trial: IAEA-ACC, Overgaard Lancet 2010

What was this trial comparing?

A

6 fractions per week vs. 5 fractions. RT is 66-70 Gy in 33-35 fx [no nimorazole as in DAHANCA 6/7]

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20
Q

Trial: IAEA-ACC, Overgaard Lancet 2010

What were the results? Conclusions?

A

5-yr LRC 42% accel vs 30% conventional
5-yr OS 35% vs 28%, p=0.07
5-yr DSS 50% vs 40%

More acute skin and mucositis in accel RT. No difference in late toxicity

If not using chemo, six fractions per week better than 5

COMMENTARY:
This study repeated the DAHANCA regimen but this time without nimorazole

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21
Q

Trial: DAHANCA 6 & 7, Overgaard Lancet 2003

What kind of trial was this?
What was the main question of this trial?

A

General -> Altered fractionation -> glottic, supraglottic pharynx, oral cavity not receiving chemo

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22
Q

Trial: DAHANCA 6 & 7, Overgaard Lancet 2003

What was the patient population?

A

glottic, supraglottic pharynx, oral cavity not receiving chemo

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23
Q

Trial: DAHANCA 6 & 7, Overgaard Lancet 2003

What was this trial comparing?

A

RT 5 fx per week vs 6 per week, dose 66-68 Gy/33-34 fx

Nimorazole given to all except for glottic

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24
Q

Trial: DAHANCA 6 & 7, Overgaard Lancet 2003

What were the results? Conclusions?

A 
5-yr LRC 70% 6 fx vs 60%
Larynx preservation 80% vs 68%
5-yr DSS 73% vs 66%
No change in OS
Acute morbidity more frequent with 6 fx but was transient

Shortening of treatment time to 6 fx per week is beneficial in H&N cancer. Has become standard in Denmark.

COMMENTARY:
Note the use of the hypoxic radiosensitizer nimorazole in this trial in all sites but glottic

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25
Q

Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017

What kind of trial was this?
What was the main question of this trial?

A

General - > Altered fractionation -> head & neck meta-analysis

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26
Q

Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017

What was the patient population?

A

head & neck meta-analysis

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27
Q

Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017

What was this trial comparing?

A

Meta-analysis of 15 trials evaluating the benefit of altered fractionation (defined as either hyperfx, accelerated, or accel with dose reduction) compared to conventional fx
Update: Meta-analysis of 33 trials
Comparison 1: Primary or post op conv fx vs. altered fx
Comparison 2: conv fx chemoRT vs. altered fx RT alone

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28
Q

Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017

What were the results? Conclusions?

A

5-yr OS benefit of +3.4% with altered fractionation (best benefit with hyperfx, +8%)
5-yr LC benefit of +6.4%

Update:
Comparison 1: Altered fx benefit in OS: 5-yr +3.1% and 10-yr +1.2%
OS benefit only in hyperfx group: 5-yr OS +8.1% and 10-yr OS +3.9%
Comparison 2: OS worse with hyperfx RT alone vs. conv fx chemoRT, 5-yr OS -5.8% and 10-yr OS -5.1%

Altered fractionation gives benefit in OS and LC.

Update confirms that hyperfx RT, as well as conv fx chemoRT, is a standard of care for H&N. Hyperfx RT with chemo remains to be tested.

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29
Q

Trial: EORTC 22931; Bernier NEJM 2004

What kind of trial was this?
What was the main question of this trial?

A

General - > addition of chemo to adjuvant RT -> T3+, N2+, or ECE, +margin, PNI

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30
Q

Trial: EORTC 22931; Bernier NEJM 2004

What was the patient population?

A

T3+, N2+, or ECE, +margin, PNI

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31
Q

Trial: EORTC 22931; Bernier NEJM 2004

What was this trial comparing?

A

PORT 66 (54 Gy to low risk plus boost to 66 Gy, total 33 fx) vs. same RT + 3 cycles cisplatin

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32
Q

Trial: EORTC 22931; Bernier NEJM 2004

What were the results? Conclusions?

A

5-yr PFS 36% vs. 47%
5-yr OS 40% vs. 53%
3-yr OS 49% vs 65%
5-yr LRC 69% vs. 82%

Post-op chemoRT more effective than RT alone

COMMENTARY:
Comparative analysis of this and RTOG 95-01 showed that +margins and ECE are the only groups with survival advantage in both. Trend if stage III-IV, PNI, LVI, LNs in levels IV-V. (Bernier, Head Neck 2005)

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33
Q

Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012

What kind of trial was this?
What was the main question of this trial?

A

General -> Addition of chemo to adjuvant RT -> operable H+N with ≥ 2LN, ECE, or + margin

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34
Q

Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012

What was the patient population?

A

operable H+N with ≥ 2LN, ECE, or + margin

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35
Q

Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012

What was this trial comparing?

A

PORT 60 Gy (with or without 6 Gy boost) vs. same RT + 3 cycles cisplatin

36
Q

Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012

What were the results? Conclusions?

A

2-yr DFS 54 vs. 43%
LRC 82 vs. 72%
trend for improved OS 63 vs. 57%

Update: For positive margins or ECE:
10 yr LRC 67% vs 79%
10 yr OS 20% vs 27%

Post-op chemoRT improves OS, DFS and LRC

COMMENTARY:
Common question: What doses did the two trials use? EORTC used 66 Gy, and although RTOG used a base dose of 60 Gy, a 6 Gy boost was allowed to =66 Gy
Comparative analysis of this and EORTC 22931 showed that +margins and ECE are the only groups with survival advantage in both (Bernier, Head Neck 2005)

37
Q

Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009

What kind of trial was this?
What was the main question of this trial?

A

General -> Concurrent chemo -> H&N SCC trials comparing local treatment with chemo or without

38
Q

Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009

What was the patient population?

A

Meta-analysis of 93 H&N SCC trials comparing local treatment with chemo or without

39
Q

Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009

What was this trial comparing?

A

Chemo (all forms of sequencing) had an absolute 5-yr OS benefit of +4.5%. If concurrent chemo, 5-yr OS benefit is +8%.

40
Q

Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009

What were the results? Conclusions?

A

Concurrent chemo has a confirmed benefit which is greater than that of induction chemo.

COMMENTARY:
Platinum agent better than other chemo

41
Q

Trial: University of Alabama Birmingham; Bonner NEJM 2006

What kind of trial was this?
What was the main question of this trial?

A

General -> addition of concurrent cetuximab to RT -> Stage III or IV nonmetastatic SCC of oropharynx, hypopharynx, or larynx

42
Q

Trial: University of Alabama Birmingham; Bonner NEJM 2006

What was the patient population?

A

Stage III or IV nonmetastatic SCC of oropharynx, hypopharynx, or larynx

43
Q

Trial: University of Alabama Birmingham; Bonner NEJM 2006

What was this trial comparing?

A

RT conventional 70 Gy, or hyperfrac 72-76.8 Gy in 1.2 BID , or CCB 72 Gy in 42 fx

with cetuximab vs without (400mg/m2 loading then 250 weekly throughout RT)

44
Q

Trial: University of Alabama Birmingham; Bonner NEJM 2006

What were the results? Conclusions?

A

Median LC 24 vs. 15 mos
2-yr LC 50% vs 41%
median OS 49 vs. 29 mos
3-yr OS 55% vs 45%. Acneiform rash and infusion reactions more common, but otherwise not more toxic.
OS for grade 2-4 acneiform rash 69 mos vs 25 without
Favorable factors on analysis: oropharynx, EGFR >50%, hyperfx, CCB, node positive, age <65

Cetuximab improves LC and reduces mortality compared to no concurrent therapy.

COMMENTARY:
Because of subanalysis, an early misconception of the trial led to some treating all oropharynx with cetuximab. Note that trials have not shown cetuximab to be superior to cisplatin. Later studies implicated p16 as the factor that signals response to cetuximab.

45
Q

Trial: DeCIDE; Cohen JCO 2014

What kind of trial was this?
What was the main question of this trial?

A

General -> induction chemo -> N2 or N3 SCC of H&N

46
Q

Trial: DeCIDE; Cohen JCO 2014

What was the patient population?

A

N2 or N3 SCC of H&N

47
Q

Trial: DeCIDE; Cohen JCO 2014

What was this trial comparing?

A

TPF induction then THF-RT vs THF-RT alone

H is hydroxyurea. RT was BID. Concurrent chemo give 6 cycles of every other week.

48
Q

Trial: DeCIDE; Cohen JCO 2014

What were the results? Conclusions?

A

OS, RFS, and DMFS unchanged
Mortality 28% vs 31% (p=0.69)
Serious adverse events more common in induction arm 47% vs 28%

No benefit to induction THF

49
Q

Trial: PARADIGM; Haddad, Lancet 2013

What kind of trial was this?
What was the main question of this trial?

A

General -> induction chemo -> unresectable, low surgical curability T3/T4, N2/3 (but not T1N2), or organ preservation

50
Q

Trial: PARADIGM; Haddad, Lancet 2013

What was the patient population?

A

unresectable, low surgical curability T3/T4, N2/3 (but not T1N2), or organ preservation

51
Q

Trial: PARADIGM; Haddad, Lancet 2013

What was this trial comparing?

A

TPF induction then concurrent chemoRT (carbo or docetaxol) vs no induction and chemoRT (cisplatin)

If poor response to induction: 72 Gy RT in 6 weeks with docetaxel
If favorable response: 70 Gy RT in 7 weeks with carboplatin AUC 1.5

52
Q

Trial: PARADIGM; Haddad, Lancet 2013

What were the results? Conclusions?

A

3-yr OS unchanged at 73% vs. 78% and 30-yr PFS not different, 67% vs 69%. More febrile neutropenia in induction group. Terminated due to slow accrual

No benefit to induction TPF

COMMENTARY:
Clinically, some physicians do find that there are cases that benefit from neoadjuvant chemotherapy, such as a patient who is unable to lie flat due to cough or SOB from the tumor or perhaps very bulky HPV negative tumor.

53
Q

Trial: Madrid; Hitt Ann Oncol 2014

What kind of trial was this?
What was the main question of this trial?

A

General -> Induction chemo -> Locally advanced unresectable squamous cell carcinoma

54
Q

Trial: Madrid; Hitt Ann Oncol 2014

What was the patient population?

A

Locally advanced unresectable squamous cell carcinoma

55
Q

Trial: Madrid; Hitt Ann Oncol 2014

What was this trial comparing?

A

Concurrent chemoRT with induction TPF vs with PF vs concurrent chemoRT alone

56
Q

Trial: Madrid; Hitt Ann Oncol 2014

What were the results? Conclusions?

A

No change in PFS, TTF, or OS

median PFS: 15 mos vs. 14 mos vs. 14 mos
median TTF: 8 mos vs. 8 movs vs. 8 mos
median OS: 27 mos vs. 27 mos vs. 27 mos

There is no benefit to induction chemotherapy.

57
Q

Trial: VA Larynx; NEJM 1991

What kind of trial was this?
What was the main question of this trial?

A

Larynx -> Larynx preservation -> Stage III-IV (not T1N1) larynx

58
Q

Trial: VA Larynx; NEJM 1991

What was the patient population?

A

Stage III-IV (not T1N1) larynx

59
Q

Trial: VA Larynx; NEJM 1991

What was this trial comparing?

A

total laryngectomy + post-op RT (50-70Gy) vs. induction 3 cycles PF–>70 Gy if CR or PR. If no response: surgery+post-op RT

60
Q

Trial: VA Larynx; NEJM 1991

What were the results? Conclusions?

A

2-yr larynx preservation 64%. No difference in 2-yr OS at 68%.
RT had higher LF at primary 12% vs 2%
Regional LF no difference: 8% vs 5%
Improved DM: 11% vs 17%, p=0.04

Organ preservation feasible without compromising OS

COMMENTARY:
Salvage laryngectomy 56% in T4 and 29% if

61
Q

Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013

What kind of trial was this?
What was the main question of this trial?

A

Larynx -> Larynx preservation with concurrent CRT vs Induction vs RT alone -> Stage III-IV glottic or supraglottic

62
Q

Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013

What was the patient population?

A

Stage III-IV glottic or supraglottic (excluded extension through thyroid cartilage, large volume T4a, and >1 cm BOT involvment. Limited T4 was allowed) who would otherwise had required total laryngectomy

69% of patients were supraglottic

63
Q

Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013

What was this trial comparing?

A

RT 70Gy vs induction cisplatin and 5FU–>RT (VA regimen) vs. concurrent chemoRT plus cisplatin and 5FU x3

64
Q

Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013

What were the results? Conclusions?

A

Concurrent chemoRT increased 2-yr larynx preservation (84% vs. 72, 67%)
and 2-yr LRC (80% vs. 64, 56%)
No difference in OS, but chemo suppressed DM and improved DFS.

UPDATE JCO 2013: Deaths not attributed to larynx cancer higher with con-chemoRT 31% vs induction 21% vs 17% RT alone
10-yr Larynx pres: 82% vs 68% vs 64%
Trend to worse OS with con-chemoRT
10-yr OS 28% vs 39% vs 32%
10-yr LC 69% vs 54% vs 50%
10-yr DMF 84% vs 84% vs 76%
<3% with inability to swallow

CONCLUSION:
Concurrent chemoRT improves larynx preservation and LRC. No diff in OS

On update, trend to worse OS with con chemoRT.

COMMENTARY:
With this trial and GORTEC 2000-01, for some there is still some question regarding the usefulness of induction chemotherapy in larynx despite the results of the PARADIGM, DeCIDE, and Madrid trials.

There are late deaths in the concurrrent chemo arm at 10 years. Toxicity and aspiration?

65
Q

Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012

What kind of trial was this?
What was the main question of this trial?

A

Hypopharynx -> Larynx preservation -> SCC of pyriform sinus or AE fold

66
Q

Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012

What was the patient population?

A

SCC of pyriform sinus or AE fold

67
Q

Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012

What was this trial comparing?

A

Similar to VA trial: surgery + PORT vs. induction cis/5FU –> RT if CR only (PR’s went on to surg)

68
Q

Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012

What were the results? Conclusions?

A

Local failure trend to higher with RT, but fewer distant failures for induction chemo
5-yr OS same at 35%
10-yr OS 13.8% vs. 13.1%
10-yr chemoRT survival with functional larynx 8.7%
10-yr PFS 8.5% vs 11%
ChemoRT resulted in less DM
Larynx preservation 42% at 3 years, 35% at 5 years

Larynx preservation treatment with induction chemo is the new standard treatment for hypopharynx cancer.

69
Q

Trial: Helsinki Finland; Aaltonin IJROBP 2014

What kind of trial was this?
What was the main question of this trial?

A

Larynx - XRT vs CO2 laser- T1a Larynx

70
Q

Trial: Helsinki Finland; Aaltonin IJROBP 2014

What was the patient population?

A

T1a Larynx

71
Q

Trial: Helsinki Finland; Aaltonin IJROBP 2014

What was this trial comparing?

A

66 Gy vs. CO2 laser

blinded experts rated voice quality on GRBAS scale, patient self-assessed voice quality and ADL impact, and blinded video strobe

72
Q

Trial: Helsinki Finland; Aaltonin IJROBP 2014

What were the results? Conclusions?

A

Overall similar voice quality. CO2 laser group had wider glottal gap and more breathy voice.

RT group had less hoarseness related inconvenience at 2 years (p=0.007).

RT seems to provide superior voice outcomes compared to surgery for early stage larynx cancer.

73
Q

Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014

What kind of trial was this?
What was the main question of this trial?

A

Oropharynx - Risk stratification, benefit of accelerated RT -> Stage III-IV SCC or oral cavity, oropharynx, hypopharyx, or larynx

74
Q

Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014

What was the patient population?

A

Stage III-IV SCC or oral cavity, oropharynx, hypopharyx, or larynx

75
Q

Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014

What was this trial comparing?

A

Standard RT 70 Gy with cisplatin
vs.
accelerated fractionation with concominant boost (AFX-CB) 72 Gy in 6 weeks concurrent cis

76
Q

Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014

What were the results? Conclusions?

A

Prognostic difference seen in HPV positive vs. negative. Overall, at 8-yr f/u no difference in OS, PFS, LRF, DM, or toxicity between regimens.

3-yr OS by RPA group (see notes on right):
Low risk: 93%
Int risk: 71%
High risk: 46%

3-yr OS HPV+ vs. HPV-: 82% vs. 57%
3-yr DM HPV+ vs. HPV-: 9% vs. 15%
3-yr LRC HPV+ vs. HPV-: 86% vs. 65%

8-yr results for good risk HPV+ (T1-2N1-2b or T3N0-N2b, and ≤10 py - pack years):
LRF 86%, OS 81%, DM 8.3%

There is no difference in LRF, PFS, OS, DM, and toxicity in AFX-CB vs. standard RT.

An important reference to show HPV+ tumors can do very well without surgery.

This trial is commonly referenced for its useful prognostic algorithms.

RPA risk groups:
Low: p16+ with <10 py any, or p16+ with >10 py and N0-2a
Int: p16+ and >10py and N2b-3
or p16- and <10py and T2-3
High: p16- with >10py, or p16- with <10 py and T4

77
Q

Trial: ORATOR; Nichols et al, ASCO 2019

What kind of trial was this?
What was the main question of this trial?

A

Oropharynx - TORS vs ChemoRT -> Oropharynx T1-2, N0-1 or N2b (up to two nodes ≤ 3 cm) HPV+/-

78
Q

Trial: ORATOR; Nichols et al, ASCO 2019

What was the patient population?

A

Oropharynx T1-2, N0-1 or N2b (up to two nodes ≤3cm) HPV+/-

88% were HPV+

79
Q

Trial: ORATOR; Nichols et al, ASCO 2019

What was this trial comparing?

A

TORS and neck dissection
vs.
RT with or without chemotherapy

80
Q

Trial: ORATOR; Nichols et al, ASCO 2019

What were the results? Conclusions?

A

1-yr dysphagia scores were better with RT, but not to a clinically meaningful degree, p=0.042
Feeding tube 1 pt vs. 0 pts
grade 2+ toxicity 91% vs. 100%, p=0.24
Similar OS and PFS
One TORS bleeding death. More trismus with TORS. More neutropenia, constipation, and tinnitus with RT.

QOL results are demonstrated. RT resulted in superior 1-yr dysphagia scores but not to a clinically meaningful degree.

81
Q

Trial: Princess Margaret; O’ Sullivan IJROBP 2001; Huang et al IJROBP 2017

What kind of trial was this?
What was the main question of this trial?

A

Oropharynx - radiation to the ipsilateral tonsil, no surgery

82
Q

Trial: Princess Margaret; O’ Sullivan IJROBP 2001; Huang et al IJROBP 2017

What was the patient population?

A

Ipsilateral tonsil, no surgery. Retrospective. RT only to ipsilateral side, no chemo.

83
Q

Trial: Princess Margaret; O’ Sullivan IJROBP 2001; Huang et al IJROBP 2017

What was this trial comparing?

A

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84
Q

Trial: Princess Margaret; O’ Sullivan IJROBP 2001; Huang et al IJROBP 2017

What were the results? Conclusions?

A

Contralateral failure: T1 0%, T2 1.5%, T3 10%, T4 0%, N0 0%, N1 9%, N2/3 0%. Sig risk for failure if involving medial one third of palate, BOT
No difference in LC or RC for HPV+ vs. HPV- in 379 patients from 1999-2014

Ispilateral neck radiation in tonsil cancer results in excellent control.

There is no difference per HPV status.

85
Q

Trial

What kind of trial was this?
What was the main question of this trial?

What was the patient population?

What was this trial comparing?

What were the results? Conclusions?

A

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