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• W2149768900 abstract "Evidence about the benefit of IMRT to reduce serious late effects specifically in pts with HPV+ oropharyngeal squamous cell carcinoma (OPSCC) treated with CRT is sparse. We investigated the impact of IMRT vs standard 3-field radiation therapy (3D-RT) on late effects outcomes in this pt cohort. Pts with HPV + stage III-IVb OPSCC treated with CRT between 2002 and 2012 and rendered disease free were identified from an IRB approved registry. Pts who tested positive for HPV DNA by in-situ hybridization, or had diffuse and strong (>75%) staining for p16 by immunohistochemistry were included. Radiation therapy (RT) was administered once (79%) or twice daily (21%) to a total dose of 70-74.4 Gy. 3D-RT was used in the earlier years (65%) while IMRT with daily cone beam CT and 2-3 mm CTV and PTV expansions, respectively, was used more recently (35%). Most patients were treated with Cisplatin and 5-Fluorouracil (62%), while more recently patients were treated with Cisplatin (26%), or Cetuximab (9%) at standard dosing. Toxicity was scored according to CTCAE v4.0. Significant late toxicity was defined as any grade ≥3, or any persistent grade 2 fibrosis, dysphagia, osteoradionecrosis, trismus, pain, hoarseness, or hearing loss that occurred >3 months after the completion of treatment. Xerostomia, taste and skin changes were excluded from this combined endpoint. Logistic regression analysis was performed to identify factors associated with significant late toxicity. Of the 197 pts included in this study, the majority were white (95%), men (91%), and 32% were never smokers. The median age was 56, median KPS 90, and median f/u was 39.4 months. At last follow-up, 91% of patients returned to a normal diet, while 6.5% had a limited oral diet and 2.5% were feeding tube dependent. 5-FU based chemotherapy (43% vs 16%; p = <0.0001) and 3D-RT (44% vs 13%; p<0.0001) were significantly associated with higher rates of significant late toxicity. In patients treated with once daily IMRT and non-5-FU based chemotherapy, the rate of significant late toxicity was only 5.7%. On MVA, not using IMRT was associated with the highest risk of significant late toxicity (OR 3.4; p = 0.005), overshadowing smoking status, T stage, neck dissection and chemotherapy type. Pts with HPV + OPSCC treated with IMRT have fewer significant late effects than those treated with 3D-RT. Nearly all pts treated with IMRT and non 5-FU based chemotherapy have minimal significant late effects and excellent long term pharyngeal function." @default.
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• W2149768900 date "2014-09-01" @default.
• W2149768900 modified "2023-10-06" @default.
• W2149768900 title "Intensity Modulated Radiation Therapy (IMRT) Reduces Late Toxicity in Patients With Human Papillomavirus–Associated (HPV+) Oropharyngeal Carcinoma Treated With Chemoradiation Therapy (CRT)" @default.
• W2149768900 doi "https://doi.org/10.1016/j.ijrobp.2014.05.1579" @default.
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