Decreasing the Dose and Volume of Elective Nodal Radiotherapy in HPV-Associated Oropharyngeal Cancer: How Low Can We Go?
Menée à l'aide de données portant sur 276 patients atteints d'un carcinome oropharyngé localement avancé associé au papillomavirus humain et ayant reçu une chimioradiothérapie concomitante entre 2017 et 2019 (âge médian : 61 ans ; 89,5 % d'hommes), cette étude analyse l'efficacité, du point de vue du contrôle local, d'une réduction de la dose de radiothérapie et du volume cible (régions ganglionnaires et périphériques)
With good reason, the treatment de-escalation landscape for human papillomavirus (HPV)−associated oropharyngeal cancer has become increasingly crowded, with competing and complementary paradigms of de-escalation in various stages of development. Driven by changing epidemiologic findings and improved outcomes, the focus of therapy has shifted toward mitigating long-term adverse effects through de-escalating treatment. Strategies for de-escalation have largely centered on reduction of the highest radiation dose, increased use of surgical techniques, and leveraging systemic therapies to decrease radiation doses to key organs at risk. However, the concept of lower-dose target reduction—reduction in the elective regions treated with radiotherapy, not just areas of highest dose—as a means of de-escalation is lesser known but perhaps just as relevant for achieving that end.
JAMA Oncology , éditorial, 2021