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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