Patient-Reported Toxicity With Radiation Deintensification in Human Papillomavirus–Associated Oropharynx Cancer: ECOG-ACRIN E2399 and E1308

Authors:
Publisher website
Google Scholar
Abstract
PURPOSE: E2399 showed higher response rates and survival for human papillomavirus–associated (HPV+) oropharynx (OP) cancer than for HPV-negative OP cancer. E1308, a follow-up prospective phase II trial in patients with HPV+ OP, hypothesized that reduced radiation (54Gy) may achieve comparable tumor control in patients who achieve a complete clinical response to induction chemotherapy and that toxicities would be ameliorated. METHODS: Acute and late toxicities for both E2399 and E1308 were recorded prospectively using a battery of patient-reported outcomes (PROs). General quality of life (QOL) PROs used on E1308 included KATZ-Index of Independence in Activities of Daily Living (ADL), Brief Fatigue Index, Instrumental Activities of Daily Living, Baecke, and Community Health Activities Model Program for Seniors Physical Activity Questionnaire; head and neck cancer-specific PROs were Functional Assessment of Cancer Therapy – Head & Neck (FACT-HN) and the Vanderbilt Head and Neck Symptom Survey Version 2 (VHNSSv2). E2399 used the FACT-HN. Toxicities were correlated with both intensity-modulated radiation therapy (IMRT) dose (69.3Gy v 54Gy) used on E1308 and with the IMRT technique used on E1308 versus three-dimensional conformal radiation therapy (3DRT) used on E2399. RESULTS: Radiation dose reduction resulted in significantly decreased toxicities as detected with VHNNSv2 and FACT-HN PRO instruments. The VHNSSv2 showed that late symptoms are significantly reduced by lowering IMRT to 54Gy: eating solids ( P = .011), liquids ( P = .004), voice changes ( P = .026), dry mouth ( P = .02), and neck and shoulder movements ( P = .03). FACT-HN showed less difficulty in eating solids at 6 months ( P = .054), as well as voice strength and quality ( P = .038). Comparing IMRT 69.3Gy with 3DRT 70Gy, the FACT-HN showed eating solids at 12 months ( P = .0067) and greater ability to eat foods the patient liked ( P = .0103) favored IMRT. CONCLUSION: Both radiation dose reduction and using IMRT decreased toxicities in a variety of QOL PROs. Head and neck–specific PROs are more sensitive than general PROs. Interinstrument corroboration validates the FACT-HN and VHNSSv2 utility for treatment deintensification evaluation.

This publication has 31 references indexed in Scilit: