Is Dose Escalation of Postoperative Radiotherapy Needed for Head/Neck Squamous Cell Carcinoma?
Posted: Tuesday, September 3, 2019
A higher dose of postoperative radiation might not improve survival for patients with squamous cell carcinoma of the head and neck compared with standard dosing, according to results published in the journal Head & Neck. Thomas J. Galloway, MD, of the Department of Radiation Oncology at Fox Chase, Philadelphia, and colleagues believe further studies are necessary to clarify the benefits of increasing doses of adjuvant radiation in this patient population.
“It is sometimes human nature to think that more is better, and the guidelines on the topic have a range of doses with no specific recommendation,” said Dr. Galloway, in a Fox Chase press release. “However, according to these data, there is no evidence to support routine dose escalation in the adjuvant radiation of head and neck patients.”
The investigators analyzed data from the National Cancer Database from a total of 15,836 patients with primary head and neck squamous cell carcinoma who were treated between 2004 and 2014. The patients received either a standard dose of radiation or a high dose of radiation; of those in the latter group, 14.3% received a dose greater than 66 Gy.
When the investigators adjusted for poor prognostic factors, high-dose radiotherapy was associated with increased mortality (hazard ratio = 1.09, 95% confidence interval [CI] = 1.02–1.16). In addition, high-dose radiotherapy was not associated with an improvement in survival in patients with a nonoropharyngeal or human papillomavirus (HPV)-negative oropharyngeal primary tumor that had positive margins, at least five positive lymph nodes, and/or extranodal extension (hazard ratio = 1.01, 95% CI = 0.91–1.12).
According to the authors, “the results are consistent with recent single institution randomized data showing no dose response in head/neck squamous cell carcinoma in the postoperative setting.”
Disclosure: The study authors’ disclosure information can be found at onlinelibrary.wiley.com.