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. 2022 Dec;10(24):1391.
doi: 10.21037/atm-22-5935.

Reduced-dose radiation in human papillomavirus-associated oropharyngeal carcinoma can improve outcome: a systematic review and meta-analysis

Affiliations

Reduced-dose radiation in human papillomavirus-associated oropharyngeal carcinoma can improve outcome: a systematic review and meta-analysis

Meng-Qi Yang et al. Ann Transl Med. 2022 Dec.

Abstract

Background: Despite its effectiveness, the standard course of chemoradiation for the treatment of human papillomavirus (HPV)-related oropharyngeal carcinoma (OPC) results in considerable treatment-related adverse effects. Studies proved that HPV-positive OPC is very sensitive to radiotherapy. Using de-escalation therapy as a new strategy is critical to maintaining positive outcomes while alleviating side effects. However, some studies hold that reduced dose causes insufficient effect on tumor killing. We conducted this systematic review and meta-analysis of survival and adverse reactions in patients with HPV-related OPC by retrospective analysis and evaluated the therapeutic effect of reducing the radiation dose.

Methods: Data were double-selected and extracted by searching seven electronic databases, Original studies in all language treated HPV-associated OPC with reduced-dose and standard-dose therapies were included. Overall survival (OS), progression-free survival (PFS), and incidence rates of adverse events were obtained by pooling analyses. Statistical analyses were performed using RStudio Version 1.1.383 (RStudio, Boston, MA, USA) via the Meta-Analysis R Package (metafor). Heterogeneity was evaluated using the I2 statistic and the Cochran Q test. We used Stata (version 15.0) for forest graph.

Results: Thirteen studies were included in this meta-analysis, involving a dose range of 66-70 Gy for the standard treatment regimen and <66 Gy for the reduced-dose group. There was no significant difference in the age of the patients in the standard and the reduced treatment groups (60.9±5.9 vs. 58.6±2.4 years). Nine studies were included as standard cohort and thirteen studies were enrolled as reduced-dose cohort. The 2- and 3-year overall survival rates in the reduced-dose group (95.66% and 91.51%, respectively) were superior to those in the standard-dose group (88.36% and 87.46%, respectively). There was no significant difference in PFS between the two groups. A systematic review of articles on dose reduction and the standard dose was also conducted. The most common complication in reduced-dose radiation was oral mucositis (36.4%), followed by decreased white blood cell (WBC) count (30.5%) and dry mouth (29.1%).

Conclusions: Reducing the radiation dose in patients with HPV-related OPC substantially alleviates the treatment toxicities and optimizes the quality of life of patients while at the same time maintaining favorable oncologic outcomes.

Keywords: Human papillomavirus (HPV)-related; oropharyngeal cancer; radiotherapy; reduced dose.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-5935/coif). JDS reports that the current study was supported by grants from the National Natural Science Foundation of China (No. 81802740), and the Chongqing Science and Health Joint Medical Research Project (No. 2022ZDXM028). YW reports that the current study was supported by grants from the National Natural Science Foundation of China (No. 81972857), and the Natural Science Foundation of Chongqing City (No. cstc2021jscx-msxm0029). The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of study selection. Of the 13 studies included in this meta-analysis, 9 studies included both RD and SD, and 4 studies just included in RD. SD, standard dose; RD, reduced dose.
Figure 2
Figure 2
Meta-analysis (forest plot) of the OS reported in RD and SD studies. OS, overall survival; RD, reduced dose; SD, standard dose.
Figure 3
Figure 3
Meta-analysis (forest plot) of the PFS reported in RD and SD studies. PFS, progression-free survival; RD, reduced dose; SD, standard dose.

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