De-escalation of Adjuvant Radiation for Low-Risk HPV Oropharyngeal Cancers

Description

The goal of this clinical trial is to learn whether for intermediate-risk patients who have undergone Transoral Robotic Surgery for HPV/p16(+) oropharyngeal cancer and have minimal smoking history, whether these patients can be treated with a lower-than standard dose, with omission of the primary site in the oropharynx. The main questions it aims to answer are: Does radiotherapy site and dose-de-escalation lead to similar outcomes compared to historical data on tumor control in patients who are treated with standard radiation doses and treatment fields? Participants will: Undergo treatment with a lower than standard radiation dose (50Gy in 25 fractions, with either Intensity Modulated Radiation Therapy (IMRT) or proton beam therapy) and to a smaller than standard radiation field (to the neck only, excluding the original site of tumor in the oropharynx)

Conditions

Oropharynx Cancer

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Study Overview

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Study Details

Study overview

The goal of this clinical trial is to learn whether for intermediate-risk patients who have undergone Transoral Robotic Surgery for HPV/p16(+) oropharyngeal cancer and have minimal smoking history, whether these patients can be treated with a lower-than standard dose, with omission of the primary site in the oropharynx. The main questions it aims to answer are: Does radiotherapy site and dose-de-escalation lead to similar outcomes compared to historical data on tumor control in patients who are treated with standard radiation doses and treatment fields? Participants will: Undergo treatment with a lower than standard radiation dose (50Gy in 25 fractions, with either Intensity Modulated Radiation Therapy (IMRT) or proton beam therapy) and to a smaller than standard radiation field (to the neck only, excluding the original site of tumor in the oropharynx)

A Phase II Study of Post-Resection Radiation Dose and Treatment Site De-Escalation for Favorable Prognosis Human Papilloma Virus (HPV) or p16-Positive Oropharyngeal Cancer

De-escalation of Adjuvant Radiation for Low-Risk HPV Oropharyngeal Cancers

Condition
Oropharynx Cancer
Intervention / Treatment

-

Contacts and Locations

Washington

Medstar Georgetown University Hospital, Washington, District of Columbia, United States, 20007

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • * Patients must be ≥ 18 years of age on the day of signing informed consent.
  • * Patients must have a diagnosis of p16+ and/or HPV+ squamous cell carcinoma of the oropharynx (including base of tongue, glossotonsilar sulcus, tonsil, soft palate, vallecula, and/or posterior oropharyngeal wall).
  • * pathologic stage T1-2 N1 M0 (AJCC 8th ed.) stage I or T3 N0-1 M0 stage II (AJCC 8th ed.) SCCA of the oropharynx, with ≤ 5 distinct nodes involved with tumor, ≤ 2mm ECE (extracapsular extension), ≥ 2mm surgical margins at primary site.
  • * Karnofsky Performance Status (KPS) ≥ 60 within 8 weeks prior to registration.
  • * neutrophil:lymphocyte ratio ≤ 5 within 8 weeks of registration.
  • * hemoglobin count ≥ 10 within 8 weeks of registration. The patient may receive transfusion to reach this goal.
  • * current non-smoker (at least 6 months) with ≤ 15 pack-year smoking history
  • * start radiation within 8 weeks of resection (6 weeks preferable)
  • * have undergone resection of the primary site with Transoral Surgery and neck dissection of at least the ipsilateral neck
  • * Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • * Ability to understand and willingness to sign a written informed consent.
  • * Perineural invasion at primary site
  • * Lymphovascular space invasion at primary site
  • * Level 4 nodal involvement (even if resected)
  • * Retropharyngeal nodal involvement (even if resected)
  • * any intact, unresected disease
  • * nodal disease pathologically invading adjacent neck musculature
  • * Patients treated via an invasive, non-oral approach to the primary site, including jaw-splitting mandibulotomy with resection or lateral pharyngotomy
  • * Prior history of malignancy diagnosed within 2 years prior to registration, except for nonmelanomatous skin cancer that has completed treatment and the patient is deemed as being disease-free or Gleason 6 prostate cancer that is undergoing active surveillance.
  • * Patient with extracapsular extension (ECE) who has not had a biopsy of an ipsilateral neck lymph node that demonstrated squamous cell carcinoma

Ages Eligible for Study

18 Years to

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

Yes

Collaborators and Investigators

Georgetown University,

Study Record Dates

2028-12-31