The American Society for Radiation Oncology (ASTRO) issued a new clinical guideline for managing oropharyngeal cancer. The guideline establishes standard of care for curative treatment of oropharyngeal cancer with radiation therapy.
The new clinical practice guideline addresses optimal radiation doses and fractionation schedules, the integration of chemotherapy with radiation therapy, and the role of induction chemotherapy. The report states that when high-level data are absent for clinical decision-making, then treatment recommendations should incorporate patient values and preferences to determine the optimal therapeutic approach.
Oropharyngeal squamous cell cancer (OPSCC) is rapidly becoming the most commonly diagnosed head and neck malignancy. In addition, the typical patient with OPSCC has changed. Rates of human papillomavirus (HPV)-associated OPSCC have increased significantly in recent years. At the same time, rates of HPV-negative disease has decreased dramatically.
Among its recommendations, the ASTRO guideline suggests patients with stage IV and stage T3 N0-1 OPSCC undergoing treatment with definitive radiation therapy should receive concurrent high-dose intermittent cisplatin. In addition, patients who show pathologic risk factors for disease recurrence, such as positive surgical margins or positive lymph nodes following surgery, should receive adjuvant radiation therapy. Concurrent chemoradiation is strongly recommended only for high-risk patients.
1. Sher DJ, Adelstein DJ, Baj GK, et al. Radiation therapy for oropharyngeal squamous cell carcinoma: executive summary of an ASTRO Evidence-based Clinical Practice Guideline [published online April 11, 2017]. Pract Radiat Oncol. doi: 10.1016/j.prro.2017.02.002