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Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution
BACKGROUND: Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherap...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654053/ https://www.ncbi.nlm.nih.gov/pubmed/33168055 http://dx.doi.org/10.1186/s13014-020-01705-1 |
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author | Di Gravio, Eric J. Lang, Pencilla Kim, Hugh Andrew Jinwook Chinnery, Tricia Mundi, Neil MacNeil, S. Danielle Mendez, Adrian Yoo, John Fung, Kevin Mymryk, Joe S. Barrett, John W. Read, Nancy Venkatesan, Varagur Kuruvilla, Sara Mendez, Lucas C. Winquist, Eric Mitchell, Sylvia Mattonen, Sarah A. Nichols, Anthony C. Palma, David A. |
author_facet | Di Gravio, Eric J. Lang, Pencilla Kim, Hugh Andrew Jinwook Chinnery, Tricia Mundi, Neil MacNeil, S. Danielle Mendez, Adrian Yoo, John Fung, Kevin Mymryk, Joe S. Barrett, John W. Read, Nancy Venkatesan, Varagur Kuruvilla, Sara Mendez, Lucas C. Winquist, Eric Mitchell, Sylvia Mattonen, Sarah A. Nichols, Anthony C. Palma, David A. |
author_sort | Di Gravio, Eric J. |
collection | PubMed |
description | BACKGROUND: Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. METHODS: Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. RESULTS: A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). CONCLUSIONS: Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery. |
format | Online Article Text |
id | pubmed-7654053 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-76540532020-11-10 Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution Di Gravio, Eric J. Lang, Pencilla Kim, Hugh Andrew Jinwook Chinnery, Tricia Mundi, Neil MacNeil, S. Danielle Mendez, Adrian Yoo, John Fung, Kevin Mymryk, Joe S. Barrett, John W. Read, Nancy Venkatesan, Varagur Kuruvilla, Sara Mendez, Lucas C. Winquist, Eric Mitchell, Sylvia Mattonen, Sarah A. Nichols, Anthony C. Palma, David A. Radiat Oncol Research BACKGROUND: Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. METHODS: Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. RESULTS: A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). CONCLUSIONS: Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery. BioMed Central 2020-11-10 /pmc/articles/PMC7654053/ /pubmed/33168055 http://dx.doi.org/10.1186/s13014-020-01705-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Di Gravio, Eric J. Lang, Pencilla Kim, Hugh Andrew Jinwook Chinnery, Tricia Mundi, Neil MacNeil, S. Danielle Mendez, Adrian Yoo, John Fung, Kevin Mymryk, Joe S. Barrett, John W. Read, Nancy Venkatesan, Varagur Kuruvilla, Sara Mendez, Lucas C. Winquist, Eric Mitchell, Sylvia Mattonen, Sarah A. Nichols, Anthony C. Palma, David A. Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
title | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
title_full | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
title_fullStr | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
title_full_unstemmed | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
title_short | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
title_sort | modern treatment outcomes for early t-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654053/ https://www.ncbi.nlm.nih.gov/pubmed/33168055 http://dx.doi.org/10.1186/s13014-020-01705-1 |
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