Survey of Radiation Field and Dose in HPV-Positive Oropharyngeal Cancer: Is De-escalation Actually Applied in Clinical Practice?

Abstract Background: Studies on de-escalation in radiation therapy (RT) for human papillomavirus-related [HPV(+)] oropharyngeal cancer (OPC) are currently ongoing. This study investigated the current practice regarding the radiation dose and field in the treatment of HPV(+) OPC.Methods: The subcommittee on Oropharyngeal Cancer Treatment Guidelines of the Korean Society for Head and Neck Oncology (KSHNO) conducted a questionnaire on the primary treatment policy in five scenarios. Among them, for HPV(+) OPC scenarios, radiation oncologists were questioned regarding the field and dose of RT.Results: Forty-two radiation oncologists responded to the survey. In definitive concurrent chemoradiotherapy (CCRT) treatment for stage T2N1M0 OPC, most respondents prescribed a dose of >60 Gy to the primary tonsil and involved ipsilateral lymph nodes (LNs). However, eight of the respondents prescribed a relatively low dose of ≤54 Gy. Various doses were prescribed for the non-involved chain, and 50 and 54 Gy were the most commonly selected doses. For stage T2N1M0 OPC, postoperative adjuvant RT was prescribed by eight and nine respondents with a lower dose of ≤50 Gy for the ipsilateral tonsil and involved neck, respectively. In definitive CCRT in complete remission after induction chemotherapy for initial stage T2N3M0 OPC, most respondents included the contralateral LNs with less de-escalated radiation fields. De-escalation of the tonsil and involved neck were performed by eight and seven respondents, respectively. Regarding whether de-escalation is applied in radiotherapy for HPV(+) OPC, 27 (64.3%) did not do it at present, and 15 (35.7%) were doing or considering it.Conclusions: The field and dose of prescribed treatment varied between institutions in Korea. Among them, dose de-escalation of RT in HPV(+) OPC was observed in approximately 20% of the respondents. Consensus guidelines will be set in the near future after the completion of ongoing prospective trials.

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Regarding “Comparing unilateral vs. bilateral neck management in lateralized oropharyngeal cancer between surgical and radiation oncologists: An international practice pattern survey” – Intra- and inter-specialty variability and the underutilisation of unilateral radiotherapy as treatment de-intensification

Oral Oncology ◽

10.1016/j.oraloncology.2021.105248 ◽

2021 ◽

pp. 105248

Author(s):

Lachlan McDowell ◽

June Corry

Keyword(s):

Oropharyngeal Cancer ◽

Practice Pattern ◽

Radiation Oncologists

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Comparing unilateral vs. bilateral neck management in lateralized oropharyngeal cancer between surgical and radiation oncologists: An international practice pattern survey

Oral Oncology ◽

10.1016/j.oraloncology.2020.105165 ◽

2021 ◽

Vol 114 ◽

pp. 105165

Author(s):

John R. de Almeida ◽

Valerie Seungyeon Kim ◽

Brian O'Sullivan ◽

David P. Goldstein ◽

Scott V. Bratman ◽

...

Keyword(s):

Oropharyngeal Cancer ◽

Practice Pattern ◽

Radiation Oncologists

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Significance of Concurrent Chemoradiotherapy as Primary Treatment in Patients with Metastatic Cervical Cancer

Current Oncology ◽

10.3390/curroncol28030155 ◽

2021 ◽

Vol 28 (3) ◽

pp. 1663-1672

Author(s):

Satomi Hattori ◽

Nobuhisa Yoshikawa ◽

Kazumasa Mogi ◽

Kosuke Yoshida ◽

Masato Yoshihara ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Size ◽

Concurrent Chemoradiotherapy ◽

Primary Treatment ◽

Prognostic Impact ◽

Primary Tumor Size ◽

Node Metastasis ◽

Aortic Lymph Node

(1) This study investigated the prognostic impact of tumor size in patients with metastatic cervical cancer. (2) Methods: Seventy-three cervical cancer patients in our institute were stratified into two groups based on distant metastasis: para-aortic lymph node metastasis alone (IIIC2) or spread to distant visceral organs with or without para-aortic lymph node metastasis (IVB) to identify primary tumor size and concurrent chemoradiotherapy. (3) Results: The overall survival (OS) for patients with a tumor >6.9 cm in size was significantly poorer than that for patients with a tumor ≤6.9 cm in the IVB group (p = 0.0028); the corresponding five-year OS rates in patients with a tumor ≤6.9 and >6.9 cm were 53.3% and 13.4%, respectively. In the multivariate analysis, tumor size and primary treatment were significantly associated with survival in metastatic cervical cancer. (4) Conclusions: Tumor size ≤6.9 cm and concurrent chemoradiotherapy as the primary treatment were favorable prognostic factors for patients with metastatic cervical cancer.

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Concurrent Chemoradiotherapy with S-1 (TS-1) as First-Line Treatment for Oropharyngeal Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.07.939 ◽

2009 ◽

Vol 75 (3) ◽

pp. S410

Author(s):

K. Ohnishi ◽

Y. Shioyama ◽

S. Nomoto ◽

S. Ohga ◽

T. Nonoshita ◽

...

Keyword(s):

Oropharyngeal Cancer ◽

Concurrent Chemoradiotherapy ◽

Line Treatment ◽

First Line ◽

First Line Treatment

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Systemic treatment approaches in her2-negative advanced breast cancer—guidance on the guidelines

Current Oncology ◽

10.3747/co.22.2360 ◽

2015 ◽

Vol 22 ◽

pp. 29 ◽

Cited By ~ 12

Author(s):

A.A. Joy ◽

M. Ghosh ◽

R. Fernandes ◽

M.J. Clemons

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

De Novo ◽

Treatment Guidelines ◽

Early Stage ◽

Symptom Control ◽

Growth Factor Receptor ◽

Disease Recurrence ◽

Primary Treatment ◽

Advanced Breast

Despite advancements in the treatment of early-stage breast cancer, many patients still develop disease recurrence; others present with de novo metastatic disease. For most patients with advanced breast cancer, the primary treatment intent is noncurative—that is, palliative—in nature. The goals of treatment should therefore focus on maximizing symptom control and extending survival. Treatments should be evaluated on an individualized basis in terms of evidence, but also with full respect for the wishes of the patient in terms of acceptable toxicity. Given the availability of extensive reviews on the roles of endocrine therapy and her2 (human epidermal growth factor receptor 2)–targeted therapies for advanced disease, we focus here mainly on treatment guidelines for the non-endocrine management of her2-negative advanced breast cancer in a Canadian health care context.

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P215 Systematic Review of Primary Treatment Techniques in Oropharyngeal Cancer

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.132.8.907-b ◽

2006 ◽

Vol 132 (8) ◽

pp. 907

Author(s):

J. R. Harris ◽

C. Diamond ◽

R. Hart ◽

P. Dziegielewski ◽

H. Seikaly

Keyword(s):

Systematic Review ◽

Oropharyngeal Cancer ◽

Primary Treatment ◽

Treatment Techniques

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Diagnostic utility of (18)f-fluciclovine positron emission tomography (FACBC) in biochemically recurrent (BCR) prostate cancer (PCa) based on prior primary treatment modality for localized disease and the impact of FACBC findings on treatment selection.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.34 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 34-34

Author(s):

Marina Nasrin Sharifi ◽

Petra Lovrec ◽

Jens C. Eickhoff ◽

Aria Kenarsary ◽

David Frazier Jarrard ◽

...

Keyword(s):

Median Time ◽

Treatment Guidelines ◽

Recurrent Disease ◽

Primary Treatment ◽

Prostate Bed ◽

Primary Treatment Modality ◽

Positron Emission ◽

Treatment Data ◽

Detection And Localization ◽

The Impact

34 Background: Management of BCR PCa requires accurate assessment of location and extent of recurrent disease. FACBC has been shown to be a sensitive modality for detection and localization of recurrent disease but treatment guidelines are based on the findings of conventional (conv) imaging, including computed tomography, magnetic resonance imaging, or bone scintigraphy, and little is known about how prior treatment impacts FACBC findings and concordance with conv scans. Methods: This single-center retrospective study included 137 patients (pts) who had FACBC for BCR at the University of Wisconsin-Madison from 10/2017-10/2019. Clinical, pathological, imaging, and treatment data were collected by chart review. Pts were classified by type of primary treatment for localized PCa, either radical prostatectomy (RP) or radiation therapy (RT). Findings of conv scans performed within 4 weeks prior or any time after FACBC were collected. Results: 105 pts had RP and 32 pts had RT as their primary PCa treatment. Gleason score and PSA at diagnosis were similar between groups. Median PSA at time of FACBC was higher in the RT compared to RP group (3.3 vs 0.7 ng/dL) and median time from initial diagnosis to FACBC was longer (70 vs 55 months). Frequency of (+) FACBC findings was higher in the RT group (66% vs 47%); only 3% of pts in the RT group had a (-) FACBC compared to 29% in the RP group. The rate of (+) lesions in the prostate/prostate bed was higher in the RT group (41% vs 22%), while the rate of (+) lesions in pelvic nodes and distant sites was similar between groups. Of 69 pts who also had conv imaging, 61% had concordant conv imaging findings. In the RT group, conv and FACBC findings were similar in 47% of pts and not similar in 28%. In the RP group, conv and FACBC findings were similar in 26% of pts and not similar in 17%. Management after FACBC is listed in table. Median time from FACBC to first (+) conv scans was 6 (range: 0-18) and 5 (range: 0-17) months for RT and RP groups, respectively. Conclusions: In this large retrospective cohort, pts treated with initial RT had a longer median time from diagnosis to FACBC and higher median PSA at the time of FACBC compared to the RP group. RT patients had a higher rate of (+) FACBC findings but were more likely to continue on observation. The median time from FACBC to first (+) conv scan was 5-6 months, supporting the role of FACBC in earlier detection of recurrent disease in both groups of patients. Further analysis of concordance between FACBC and conv imaging is in process. [Table: see text]

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National survey of radiation oncologists’ practice patterns regarding hormone-naïve prostate cancer with bone metastases

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa111 ◽

2020 ◽

Vol 50 (10) ◽

pp. 1188-1194

Author(s):

Katsumasa Nakamura ◽

Hitoshi Ishikawa ◽

Tetsuo Akimoto ◽

Manabu Aoki ◽

Shinji Kariya ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Practice Patterns ◽

Primary Treatment ◽

Dose Fractionation ◽

Radiation Oncologists ◽

Multiple Bone Metastases ◽

Single Bone ◽

Radiotherapy Dose

Abstract Objective To explore radiation oncologists’ attitudes and practice patterns of radiotherapy for hormone-naïve prostate cancer with bone metastases in Japan. Methods An internet-based survey was distributed to board-certified radiation oncologists of the Japanese Society of Radiation Oncology. Three hypothetical cases were assumed: hormone-naïve prostate cancer with single, three or multiple non-symptomatic bone metastases. The respondents described their attitude regarding such cases, treatment methods and the radiotherapy dose fractionation that they would recommend. Results Among the 1013 board-certified radiation oncologists in Japan, 373 (36.8%) responded to the questionnaire. Most of the respondents (85.0%) believed that radiotherapy may be applicable as a primary treatment for hormone-naïve prostate cancer with bone metastases in some circumstances. For Case 1 (single bone metastasis), 55.0% of the respondents recommended radiotherapy for the prostate and bone metastasis. For Case 2 (three bone metastases), only 24.4% recommended radiotherapy for all lesions, and 31.4% recommended radiotherapy for the prostate only. For Case 3 (multiple bone metastases), 49.1% of the respondents stated that there was no indication for radiotherapy. However, 34% of the respondents still preferred to administer radiotherapy for the prostate. The radiotherapy techniques and dose fractionations varied widely among the respondents. Conclusion Most of the respondent radiation oncologists believed that radiotherapy may be beneficial for hormone-naïve prostate cancer with bone metastases.

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