H&N Flashcards
Trial: RTOG 7303
What kind of trial was this?
What was the main question of this trial?
General H&N -> Pre-op vs Postop RT -> Advanced supraglottic larynx, hypopharynx, oropharynx, oral cavity
Trial: RTOG 7303
What was the patient population?
Advanced supraglottic larynx, hypopharynx, oropharynx, oral cavity: T2-T4, any N except N3a
Trial: RTOG 7303
What was this trial comparing?
Larynx/hypopharynx: Preop 50Gy vs. Postop 60Gy.
Oral cavity/oropharynx: Preop vs. postop vs. definitive RT
Trial: RTOG 7303
What were the results? Conclusions?
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.
Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017
What kind of trial was this?
What was the main question of this trial?
General H&N -> Dose escalation -> Stage III or IV oral cavity, oropharynx, hypopharynx, larynx
Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017
What was the patient population?
Stage III or IV oral cavity, oropharynx, hypopharynx, larynx
Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017
What was this trial comparing?
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.
Trial: MD Anderson, Peters IJROBP 1993, Rosenthal IJROBP 2017
What were the results? Conclusions?
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.
Trial: Belgium; Radiotherapy Oncology 2016
What kind of trial was this?
What was the main question of this trial?
General -> Dose escalation -> Previously untreated head and neck cancer. T1-T2N0 were allowed if elective neck radiation planned
Trial: Belgium; Radiotherapy Oncology 2016
What was the patient population?
Previously untreated head and neck cancer. T1-T2N0 were allowed if elective neck radiation planned
Trial: Belgium; Radiotherapy Oncology 2016
What was this trial comparing?
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
Trial: Belgium; Radiotherapy Oncology 2016
What were the results? Conclusions?
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
Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014
What kind of trial was this?
What was the main question of this trial?
General -> Altered fractionation -> Stage III-IV (or II for BOT/hypopharynx)
Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014
What was the patient population?
Stage III-IV (or II for BOT/hypopharynx)
Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014
What was this trial comparing?
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
Trial: RTOG 9003; Fu IJROBP 2000, Beitler, IJROBP 2014
What were the results? Conclusions?
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
Trial: IAEA-ACC, Overgaard Lancet 2010
What kind of trial was this?
What was the main question of this trial?
General -> Altered fractionation -> glottic, supraglottic pharynx, oral cavity not receiving chemo
Trial: IAEA-ACC, Overgaard Lancet 2010
What was the patient population?
glottic, supraglottic pharynx, oral cavity not receiving chemo
Trial: IAEA-ACC, Overgaard Lancet 2010
What was this trial comparing?
6 fractions per week vs. 5 fractions. RT is 66-70 Gy in 33-35 fx [no nimorazole as in DAHANCA 6/7]
Trial: IAEA-ACC, Overgaard Lancet 2010
What were the results? Conclusions?
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
Trial: DAHANCA 6 & 7, Overgaard Lancet 2003
What kind of trial was this?
What was the main question of this trial?
General -> Altered fractionation -> glottic, supraglottic pharynx, oral cavity not receiving chemo
Trial: DAHANCA 6 & 7, Overgaard Lancet 2003
What was the patient population?
glottic, supraglottic pharynx, oral cavity not receiving chemo
Trial: DAHANCA 6 & 7, Overgaard Lancet 2003
What was this trial comparing?
RT 5 fx per week vs 6 per week, dose 66-68 Gy/33-34 fx
Nimorazole given to all except for glottic
Trial: DAHANCA 6 & 7, Overgaard Lancet 2003
What were the results? Conclusions?
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
Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017
What kind of trial was this?
What was the main question of this trial?
General - > Altered fractionation -> head & neck meta-analysis
Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017
What was the patient population?
head & neck meta-analysis
Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017
What was this trial comparing?
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
Trial: MARCH-HN; Baujat Cochrane 2010, Lacos Lancet 2017
What were the results? Conclusions?
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.
Trial: EORTC 22931; Bernier NEJM 2004
What kind of trial was this?
What was the main question of this trial?
General - > addition of chemo to adjuvant RT -> T3+, N2+, or ECE, +margin, PNI
Trial: EORTC 22931; Bernier NEJM 2004
What was the patient population?
T3+, N2+, or ECE, +margin, PNI
Trial: EORTC 22931; Bernier NEJM 2004
What was this trial comparing?
PORT 66 (54 Gy to low risk plus boost to 66 Gy, total 33 fx) vs. same RT + 3 cycles cisplatin
Trial: EORTC 22931; Bernier NEJM 2004
What were the results? Conclusions?
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)
Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012
What kind of trial was this?
What was the main question of this trial?
General -> Addition of chemo to adjuvant RT -> operable H+N with ≥ 2LN, ECE, or + margin
Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012
What was the patient population?
operable H+N with ≥ 2LN, ECE, or + margin
Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012
What was this trial comparing?
PORT 60 Gy (with or without 6 Gy boost) vs. same RT + 3 cycles cisplatin
Trial: RTOG 9501; Cooper NEJM 2004, IJROBP 2012
What were the results? Conclusions?
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)
Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009
What kind of trial was this?
What was the main question of this trial?
General -> Concurrent chemo -> H&N SCC trials comparing local treatment with chemo or without
Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009
What was the patient population?
Meta-analysis of 93 H&N SCC trials comparing local treatment with chemo or without
Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009
What was this trial comparing?
Chemo (all forms of sequencing) had an absolute 5-yr OS benefit of +4.5%. If concurrent chemo, 5-yr OS benefit is +8%.
Trial: MACH-NC; Pignon Lanet 2000, Radiother Oncol 2009
What were the results? Conclusions?
Concurrent chemo has a confirmed benefit which is greater than that of induction chemo.
COMMENTARY:
Platinum agent better than other chemo
Trial: University of Alabama Birmingham; Bonner NEJM 2006
What kind of trial was this?
What was the main question of this trial?
General -> addition of concurrent cetuximab to RT -> Stage III or IV nonmetastatic SCC of oropharynx, hypopharynx, or larynx
Trial: University of Alabama Birmingham; Bonner NEJM 2006
What was the patient population?
Stage III or IV nonmetastatic SCC of oropharynx, hypopharynx, or larynx
Trial: University of Alabama Birmingham; Bonner NEJM 2006
What was this trial comparing?
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)
Trial: University of Alabama Birmingham; Bonner NEJM 2006
What were the results? Conclusions?
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.
Trial: DeCIDE; Cohen JCO 2014
What kind of trial was this?
What was the main question of this trial?
General -> induction chemo -> N2 or N3 SCC of H&N
Trial: DeCIDE; Cohen JCO 2014
What was the patient population?
N2 or N3 SCC of H&N
Trial: DeCIDE; Cohen JCO 2014
What was this trial comparing?
TPF induction then THF-RT vs THF-RT alone
H is hydroxyurea. RT was BID. Concurrent chemo give 6 cycles of every other week.
Trial: DeCIDE; Cohen JCO 2014
What were the results? Conclusions?
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
Trial: PARADIGM; Haddad, Lancet 2013
What kind of trial was this?
What was the main question of this trial?
General -> induction chemo -> unresectable, low surgical curability T3/T4, N2/3 (but not T1N2), or organ preservation
Trial: PARADIGM; Haddad, Lancet 2013
What was the patient population?
unresectable, low surgical curability T3/T4, N2/3 (but not T1N2), or organ preservation
Trial: PARADIGM; Haddad, Lancet 2013
What was this trial comparing?
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
Trial: PARADIGM; Haddad, Lancet 2013
What were the results? Conclusions?
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.
Trial: Madrid; Hitt Ann Oncol 2014
What kind of trial was this?
What was the main question of this trial?
General -> Induction chemo -> Locally advanced unresectable squamous cell carcinoma
Trial: Madrid; Hitt Ann Oncol 2014
What was the patient population?
Locally advanced unresectable squamous cell carcinoma
Trial: Madrid; Hitt Ann Oncol 2014
What was this trial comparing?
Concurrent chemoRT with induction TPF vs with PF vs concurrent chemoRT alone
Trial: Madrid; Hitt Ann Oncol 2014
What were the results? Conclusions?
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.
Trial: VA Larynx; NEJM 1991
What kind of trial was this?
What was the main question of this trial?
Larynx -> Larynx preservation -> Stage III-IV (not T1N1) larynx
Trial: VA Larynx; NEJM 1991
What was the patient population?
Stage III-IV (not T1N1) larynx
Trial: VA Larynx; NEJM 1991
What was this trial comparing?
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
Trial: VA Larynx; NEJM 1991
What were the results? Conclusions?
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
Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013
What kind of trial was this?
What was the main question of this trial?
Larynx -> Larynx preservation with concurrent CRT vs Induction vs RT alone -> Stage III-IV glottic or supraglottic
Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013
What was the patient population?
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
Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013
What was this trial comparing?
RT 70Gy vs induction cisplatin and 5FU–>RT (VA regimen) vs. concurrent chemoRT plus cisplatin and 5FU x3
Trial: RTOG 9111; Forastierre NEJM 2003, JCO 2013
What were the results? Conclusions?
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?
Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012
What kind of trial was this?
What was the main question of this trial?
Hypopharynx -> Larynx preservation -> SCC of pyriform sinus or AE fold
Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012
What was the patient population?
SCC of pyriform sinus or AE fold
Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012
What was this trial comparing?
Similar to VA trial: surgery + PORT vs. induction cis/5FU –> RT if CR only (PR’s went on to surg)
Trial: EORTC 24891; Lafebvre JNCI 1996, Ann Oncol 2012
What were the results? Conclusions?
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.
Trial: Helsinki Finland; Aaltonin IJROBP 2014
What kind of trial was this?
What was the main question of this trial?
Larynx - XRT vs CO2 laser- T1a Larynx
Trial: Helsinki Finland; Aaltonin IJROBP 2014
What was the patient population?
T1a Larynx
Trial: Helsinki Finland; Aaltonin IJROBP 2014
What was this trial comparing?
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
Trial: Helsinki Finland; Aaltonin IJROBP 2014
What were the results? Conclusions?
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.
Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014
What kind of trial was this?
What was the main question of this trial?
Oropharynx - Risk stratification, benefit of accelerated RT -> Stage III-IV SCC or oral cavity, oropharynx, hypopharyx, or larynx
Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014
What was the patient population?
Stage III-IV SCC or oral cavity, oropharynx, hypopharyx, or larynx
Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014
What was this trial comparing?
Standard RT 70 Gy with cisplatin
vs.
accelerated fractionation with concominant boost (AFX-CB) 72 Gy in 6 weeks concurrent cis
Trial: RTOG 0129; Ang et al NEJM 2010; JCO 2014
What were the results? Conclusions?
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
Trial: ORATOR; Nichols et al, ASCO 2019
What kind of trial was this?
What was the main question of this trial?
Oropharynx - TORS vs ChemoRT -> Oropharynx T1-2, N0-1 or N2b (up to two nodes ≤ 3 cm) HPV+/-
Trial: ORATOR; Nichols et al, ASCO 2019
What was the patient population?
Oropharynx T1-2, N0-1 or N2b (up to two nodes ≤3cm) HPV+/-
88% were HPV+
Trial: ORATOR; Nichols et al, ASCO 2019
What was this trial comparing?
TORS and neck dissection
vs.
RT with or without chemotherapy
Trial: ORATOR; Nichols et al, ASCO 2019
What were the results? Conclusions?
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.
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?
Oropharynx - radiation to the ipsilateral tonsil, no surgery
Trial: Princess Margaret; O’ Sullivan IJROBP 2001; Huang et al IJROBP 2017
What was the patient population?
Ipsilateral tonsil, no surgery. Retrospective. RT only to ipsilateral side, no chemo.
Trial: Princess Margaret; O’ Sullivan IJROBP 2001; Huang et al IJROBP 2017
What was this trial comparing?
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Trial: Princess Margaret; O’ Sullivan IJROBP 2001; Huang et al IJROBP 2017
What were the results? Conclusions?
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.
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?
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