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• W2027711806 abstract "We read with interest the article by Rosenthal et al regarding patterns of symptom burden during radiotherapy (RT) or concurrent chemoradiotherapy (CRT) for patients with head and neck cancer (HNC).1 Patient-reported, robust symptom-related data collection is warranted for statistical assumptions in future HNC trials in which symptom distress takes part of the endpoints. This is an important issue because recent prospective trials of cancer treatment deintensification in patients with human papillomavirus (HPV)-associated HNC have attempted to reduce treatment-related toxicity and patient symptoms while maintaining or improving established cure rates. This goal is investigated by either using upfront transoral robotic surgery (Eastern Cooperative Oncology Group 3311 trial; ClinicalTrials.gov identifier NCT01898494) or upfront induction chemotherapy followed by response-adapted (low vs standard-dose) RT (Eastern Cooperative Oncology Group E1308 trial; ClinicalTrials.gov identifier NCT01084083), or by replacing standard cisplatin chemotherapy with treatment with antiepidermal growth factor receptor (cetuximab) (Radiation Therapy Oncology Group-1016 trial, ClinicalTrials.gov identifier NCT01302834). HPV-associated HNC is a distinct disease entity with an increasing frequency, and is observed mainly in nonsmoking, nondrinking younger patients diagnosed with oropharyngeal cancer with a favorable prognosis.2, 3 Since 2000, the worldwide standard treatment for patients with locally advanced HNC has been CRT.4, 5 However, this treatment has not been uniformly adopted for patients with low-volume TNM stage III or IV oropharyngeal cancer, does not take into consideration the existence of HPV-driven cancers, and is associated with significant long-term toxicity.6 Toxicity has largely been ignored because of an evolved focus on survival as a priority. Given the very good prognosis of patients with HPV-positive HNC, one of the first questions is the possibility of omitting chemotherapy (or replacing it with cetuximab). The MARCH (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck) meta-analysis, which included 6515 patients, demonstrated a similar absolute benefit of survival (8%) using accelerated RT alone compared with CRT as in the MACH-NC (Meta-Analysis of Chemotherapy in Head and Neck Cancer) meta-analysis, which included >10,000 patients.4, 7, 8 In both meta-analyses, the absolute survival benefit for oropharyngeal cancer was similar. In patients with HPV-positive HNC, the better prognosis noted compared with patients with HPV-negative disease is related to increased locoregional control rather than the incidence of distant metastases.3, 9 The majority of patients with HPV-positive oropharyngeal cancer present with N2bN3 disease, and therefore have a risk of developing distant metastases if chemotherapy is omitted.10, 11 Moreover, in a recent meta-analysis, taxane-containing induction chemotherapy demonstrated an absolute benefit of 8% in patients with N2N3 HNC.12 Given the good locoregional control but similar incidence of distant metastases compared with patients with HPV-negative HNC, a reduction in elective neck irradiation (total radiation dose or irradiated volume) can be a solution for deintensification in patients with HPV-positive HNC. The current regimen is to deliver 45 to 50 grays to the uninvolved neck. In the modern RT era, using positron emission tomography, magnetic resonance imaging, or high-quality computed tomography, elective neck dissection or irradiation can be omitted. A recent meta-analysis assessing the detection of cervical lymph node metastases using modern imaging techniques in patients with HNC with clinically N0 disease demonstrated that minimizing morbidity by avoiding elective neck treatment is acceptable in selected cases.13 In conclusion, we are convinced that treatment-related long-term toxicity among patients with HNC is high, and the analysis of patterns of symptom burden as proposed by Rosenthal et al1 should be used as a benchmark for future symptom intervention clinical trials. No specific funding was disclosed. The authors made no disclosures. Mahmut Ozsahin, MD, PhD Jean Bourhis, MD, PhD Department of Radiation Oncology Lausanne University Medical Center Lausanne, Switzerland" @default.
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• W2027711806 date "2014-11-25" @default.
• W2027711806 modified "2023-09-23" @default.
• W2027711806 title "Treatment deintensification and symptom burden in patients with human papillomavirus-associated head and neck cancer" @default.
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• W2027711806 doi "https://doi.org/10.1002/cncr.29152" @default.
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