Deescalated Radiotherapy Tolerated After Surgery for HPV-Linked Oropharyngeal Cancer
THURSDAY, Sept. 11, 2025 -- For patients following surgery for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma, a deescalated regimen of adjuvant radiotherapy is more tolerable than standard of care, according to a study published online in the September issue of The Lancet Oncology.
Daniel Ma, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a phase 3 trial involving adults with stage III to stage IV HPV-associated oropharyngeal squamous cell carcinoma who had more than 70 percent p16-immunoreactivity on immunohistochemistry evaluation of the surgical specimen. Eligible patients were randomly assigned to receive deescalated adjuvant radiotherapy (30 to 36 Gy in 1.5 to 1.8 Gy fractions twice per day over two weeks plus intravenous docetaxel 15 mg/m² on days 1 and 8 of treatment) or standard of care (60 Gy in two Gy fractions once daily over six weeks plus intravenous cisplatin 40 mg/m2 once a week; 130 and 64 patients, respectively).
The researchers found that the cumulative chronic grade 3 or higher toxicity rate was 3 and 11 percent in the deescalated adjuvant radiotherapy and standard-of-care groups, respectively, at three to 24 months, with a cumulative chronic percutaneous endoscopic gastric tube rate of 2 and 8 percent, respectively. In the deescalated adjuvant radiotherapy group, the most common grade 3 or higher toxic effects were dysphagia, esophagitis, and hearing impairment.
"We've significantly reduced the burden of long-term side effects without compromising the effectiveness of the treatment," Ma said in a statement.
Several authors disclosed ties to the biopharmaceutical and publishing industries.
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