6.9.14: 14. Administration of Chemoradiation Therapy
- Page ID
- 53891
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Oropharyngeal cancer: Administration of Chemoradiation
Radiotherapy (RT)
- The most important part of the treatment
- 66 to 70 Gy to tumour bed and metastatic nodal disease over 6 to 7 weeks
Chemotherapy given with radiation
- Acts as a radiosensitizer i.e. increases radiation-induced DNA damage
- Increases radiation dose effect by 7-8 Gy
- When chemotherapy is added to RT to treat OPC, there is an overall survival benefit of 5.3% at 5 years
- Addition of chemotherapy gives an absolute benefit of 4.5% at 5 years
- Addition of chemotherapy increases acute side-effects of RT – as well as adding unique toxicities
- Addition of chemotherapy should not compromise ability of patient to complete RT
- “Gold standard”: Single-agent, high-dose Cisplatin 3 weekly x 3 cycles *
- Alternative regimens *
- Single-agent, high-dose Carboplatin 3 weekly x 3
- Single-agent, low-dose Cisplatin / Carboplatin weekly x 6
- Carboplatin & Paclitaxel 3 weekly x 3
- Cetuximab
- Hydroxyurea
Patients should be carefully selected for this treatment
- Performance status 0 to 1, and at least fair nutrition
- Normal / near-normal hearing especially if Cisplatin used
- Normal renal function
- Availability of supportive care: patients often need iv fluids / admission / feeding tubes / transfusions / antibiotics
- Careful monitoring throughout as well after treatment to ensure patients regain pre-treatment weight, swallowing function etc.
- Performance status 0 to 1, and at least fair nutrition
- Normal / near-normal hearing especially if Cisplatin used
- Normal renal function
- Availability of supportive care: patients often need iv fluids / admission / feeding tubes / transfusions / antibiotics
- Careful monitoring throughout as well after treatment to ensure patients regain pre-treatment weight, swallowing function etc