Dysphagia de-escalation.

July 6, 2017. A Phase III randomized trial published in Green Journal earlier this year compared treating elective nodal regions in patients with squamous cell carcinoma of any H&N site with EQD2 doses of either the standard 50 Gy vs a de-escalated regimen of 40 Gy. Between the 100 patients randomized to each arm, there were no differences in local, regional or metastatic recurrences with only 2 failures occurring in the 40 Gy volume. Unfortunately, there were also no differences in rates of dysphagia (primary endpoint). But moving beyond 2 years follow-up, we may see a greater divergence in late toxicities without as much concern for persistent disease. And as we learn more about risk-stratification (e.g., HPV and smoking statuses), perhaps we can more appropriately select which patients to place on the dose de-escalator to less toxicity.

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