ESTRO 2024 - Abstract Book

S1456

Clinical - Head & neck

ESTRO 2024

In definitive radiotherapy for head and neck cancer, elective irradiation of clinically uninvolved cervical lymph nodes is performed routinely to achieve control of clinically occult metastases. As a consequence of modern multimodal diagnostic imaging approaches, occult nodal tumor volume has significantly decreased in the last decades [1]. Therefore, the current standard elective dose level is likely higher than necessary [2]. The UPGRADE-RT trial was performed to assess safety and clinical benefit of treatment with reduced versus standard elective radiation dose in patients receiving definitive radiotherapy for head and neck cancer [3]. Here we report the results on the primary and secondary endpoints.

Material/Methods:

This randomized controlled trial included patients from 5 head and neck oncologic centers in the Netherlands. Eligible patients had to be treated with definitive radiotherapy for newly diagnosed stage T 2-4 N 0-2 M 0 squamous cell carcinoma of the oropharynx, hypopharynx or larynx. Not eligible were patients with recurrent disease, previous oncologic treatment of the neck or to be treated with chemoradiotherapy. Patients were randomized in a ratio of 1:2 to receive accelerated radiotherapy (68 Gy in 34 fractions in 5.5 weeks) with standard elective dose (50 Gy in 34 fractions) or reduced elective dose (43 Gy in 34 fractions) with institution, tumor site, T- and N-classification, HPV status as minimization factors. Participants were blinded for treatment allocation. All participants received FDG-PET/CT for radiotherapy planning and only intensity modulated radiotherapy with simultaneous integrated boost techniques were used. The primary endpoint was normalcy of diet score of the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) measured at 1 year after treatment (Table 1) [4]. A one-way ANCOVA was conducted to compare normalcy of diet score between groups with baseline score as covariate. The secondary endpoint was recurrence in electively irradiated lymph nodes within 2 years after treatment. Recurrence and survival rates were calculated using the Kaplan-Meier method.

Table 1 - Normalcy of diet score

100

Full diet (no restrictions)

90

Full diet (liquid assist)

80

All meat

70

Raw carrots, celery

60

Dry bread and crackers

50 Soft chewable Foods (e.g. macroni, canned/soft fruits, cooked vegetables, fish, hamburger, small pieces of meat)

40

Soft Foods requiring no chewing (e.g. mashed potatoes, apple sauce, pudding)

30

Pureed Foods (in blender)

20

Warm liquids

10

Cold liquids

0

Non-oral feeding (tube fed)

The study is registered at ClinicalTrials.gov, identifier NCT02442375. The study is now closed and the 2-year follow up will be completed January 25, 2024.