Guidelines Address RT for Management of HPV-Linked Oropharyngeal Cancer

Tailored recommendations presented to maximize survival and minimize side effects

By Elana Gotkine HealthDay Reporter

FRIDAY, June 28, 2024 (HealthDay News) — In a clinical practice guideline issued by the American Society for Radiation Oncology and published online June 18 in Practical Radiation Oncology, recommendations are presented for the use of radiation therapy (RT) for management of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).

Danielle N. Margalit, M.D., M.P.H., from Brigham and Women’s/Dana-Farber Cancer Center in Boston, and colleagues addressed five key questions on the use of RT for management of HPV-associated OPSCC. Recommendations were based on a systematic review of the literature and predefined consensus-building methodology.

The researchers recommended concurrent cisplatin for patients receiving definitive RT with T3 to 4 disease and/or one node >3 cm, or multiple nodes. Concurrent cetuximab, carboplatin/5-fluorouracil, or taxane-based systemic therapy are conditionally recommended for similar patients ineligible for cisplatin. RT with concurrent cisplatin is recommended for positive surgical margins or extranodal extension in the postoperative setting. For pT1 to 2 disease and a single node ≤3 cm, without other risk factors, observation is conditionally recommended. For patients treated with definitive RT with concurrent systemic therapy, 7,000 cGy in 33 to 35 fractions is recommended; 5,600 to 6,000 cGy is recommended for patients receiving postoperative RT without positive surgical margins and extranodal extension. Intensity modulated RT is recommended over three-dimensional techniques for all patients receiving RT, with reduction in dose to critical organs-at-risk. About three months after definitive RT/chemoradiation, reassessment with positron emission tomography-computed tomography is recommended.

“This updated guideline underscores the importance of tailored radiation strategies that maximize patient survival while minimizing side effects,” Margalit said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.