Management of Oropharyngeal Cancer – UK Survey Shows Variations in Practice

Rackley, T.; Caley, A.; Palaniappan, N.; Evans, Mererid

doi:10.1016/j.clon.2013.12.001

Cited by 7 publications

(9 citation statements)

References 8 publications

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“…In a recent survey, clinical oncologists from 17 UK centres were questioned about their criteria for adjuvant treatment following surgery for OPSCC: all 17 (100%) recommended POCRT for involved margins (<1 mm), 5/17 (30%) advocated its use for close margins (1-5 mm) and 15/17 (88%) for ECS. 33 It appears therefore acceptable in clinical practice to omit the use of concurrent chemotherapy with adjuvant radiotherapy for close margins, but not for involved (positive, <1 mm) margins or ECS. Accurate definition of both these pathological parameters in resected specimens is imperative to guide adjuvant treatment decision-making in clinical practice.…”

Section: Current Evidence For Adjuvant Treatmentmentioning

confidence: 99%

“…There is variation in practice, however, particularly around the issue of close margins. In a recent survey, clinical oncologists from 17 UK centres were questioned about their criteria for adjuvant treatment following surgery for OPSCC: all 17 (100%) recommended POCRT for involved margins (<1 mm), 5/17 (30%) advocated its use for close margins (1–5 mm) and 15/17 (88%) for ECS . It appears therefore acceptable in clinical practice to omit the use of concurrent chemotherapy with adjuvant radiotherapy for close margins, but not for involved (positive, <1 mm) margins or ECS.…”

Section: Current Evidence For Adjuvant Treatmentmentioning

confidence: 99%

“…Guidance on adjuvant treatment options based on adverse pathological features. *Close margin is in high-and intermediate-risk groups due to variations in practice with regard to classification 33. management of HPV-positive OPSCC, and as such, this requires to be tested in well-designed randomised trials.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Adjuvant treatment decisions for oropharyngeal cancer – is it time for a change?

Rackley

Palaniappan

Owens

et al. 2014

Clinical Otolaryngology

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Section: Current Evidence For Adjuvant Treatmentmentioning

confidence: 99%

Section: Current Evidence For Adjuvant Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Adjuvant treatment decisions for oropharyngeal cancer – is it time for a change?

Rackley

Palaniappan

Owens

et al. 2014

Clinical Otolaryngology

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“…Treatment options vary from primary radiotherapy or chemoradiotherapy to primary open or transoral surgery (transoral laser microsurgery or transoral robotic surgery), with adjuvant radiotherapy, if adverse pathological features are present on postoperative histology. There is no consensus as to the optimum treatment option and practice varies around the United Kingdom and elsewhere, however, the ultimate aim of any treatment is to achieve long‐term control and cure, with minimal morbidity.…”

Section: Introductionmentioning

confidence: 99%

Unilateral radiotherapy for surgically resected lateralized squamous cell carcinoma of the tonsil

et al. 2016

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“…There is variation in practice however, particularly around the issue of surgical margins with positive (<1 mm) and close (1-5 mm) margins being grouped together in some studies. A survey of clinical oncologists from 17 UK centres reported that all would recommend adjuvant CRT for positive surgical margins (<1 mm) whilst only 30 % would advocate its use for close margins (1–5 mm) and 88 % for ECS [ 22 ]. The relevance of the EORTC 22931 and RTOG 9501 study results should be questioned in the context of HPV-positive OPSCC.…”

Section: Introductionmentioning

confidence: 99%

PATHOS: a phase II/III trial of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery for Human papillomavirus (HPV) positive oropharyngeal cancer

et al. 2015

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BackgroundHuman papillomavirus-positive oropharyngeal squamous cell carcinoma is increasing in incidence worldwide. Current treatments are associated with high survival rates but often result in significant long-term toxicities. In particular, long-term dysphagia has a negative impact on patient quality of life and health. The aim of PATHOS is to determine whether reducing the intensity of adjuvant treatment after minimally invasive transoral surgery in this favourable prognosis disease will result in better long-term swallowing function whilst maintaining excellent disease-specific survival outcomes.Methods/DesignThe study is a multicentre phase II/III randomised controlled trial for patients with biopsy-proven Human papillomavirus-positive oropharyngeal squamous cell cancer staged T1-T3 N0-N2b with a primary tumour that is resectable via a transoral approach. Following transoral surgery and neck dissection, patients are allocated into three groups based on pathological risk factors for recurrence. Patients in the low-risk pathology group will receive no adjuvant treatment, as in standard practice. Patients in the intermediate-risk pathology group will be randomised to receive either standard dose post-operative radiotherapy (control) or reduced dose radiotherapy. Patients in the high-risk pathology group will be randomised to receive either post-operative chemoradiotherapy (control) or radiotherapy alone. The primary outcome of the phase II study is patient reported swallowing function measured using the MD Anderson Dysphagia Inventory score at 12 months post-treatment. If the phase II study is successful, PATHOS will proceed to a phase III non-inferiority trial with overall survival as the primary endpoint.DiscussionPATHOS is a prospective, randomised trial for Human papillomavirus-positive oropharyngeal cancer, which represents a different disease entity compared with other head and neck cancers. The trial aims to demonstrate that long-term dysphagia can be lessened by reducing the intensity of adjuvant treatment without having a negative impact on clinical outcome. The study will standardise transoral surgery and post-operative intensity-modulated radiotherapy protocols in the UK and develop a gold-standard swallowing assessment panel. An associated planned translational research programme, underpinned by tumour specimens and sequential blood collected as part of PATHOS, will facilitate further empirical understanding of this new disease and its response to treatment.Trial registrationThis study is registered with ClinicalTrials.gov identifier NCT02215265.

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Management of Oropharyngeal Cancer – UK Survey Shows Variations in Practice

Cited by 7 publications

References 8 publications

Adjuvant treatment decisions for oropharyngeal cancer – is it time for a change?

Adjuvant treatment decisions for oropharyngeal cancer – is it time for a change?

Unilateral radiotherapy for surgically resected lateralized squamous cell carcinoma of the tonsil

PATHOS: a phase II/III trial of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery for Human papillomavirus (HPV) positive oropharyngeal cancer

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