Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2026
Definitive IMRT alone with reduced prophylactic nodal irradiation for Early-Stage Oropharyngeal Cancer: JCOG1208.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Nakamura Satoaki, Kodaira Takeshi, Machida Ryunosuke, Nakashima Takeo, Ito Yoshinori, Nakamura Naoki, Ishikura Satoshi, Toshiyasu Takashi, Saito Yoshihiro, Takahashi Satoru, Ota Yosuke, Inada Masahiro, Murakami Yuji, Kubo Nobuteru, Sekino Yuta, Fukuda Haruhiko, Nishimura Yasumasa, Mizowaki Takashi
Аннотация
BACKGROUND: Prospective data on definitive radiotherapy alone for early-stage oropharyngeal cancer (OPC) are limited. JCOG1208 evaluated intensity-modulated radiation therapy (IMRT) alone with reduced prophylactic nodal irradiation in selected patients with early-stage OPC.
MATERIALS AND METHODS: JCOG1208 was a prospective, multi-institutional, single-arm study that enrolled patients aged 20-80 years with T1-2 N0-1 M0 OPC of the tonsil, base of tongue, or soft palate according to the UICC 7th edition. Concurrent chemotherapy was not permitted. Patients received two-step adaptive IMRT to 70 Gy in 35 fractions, including 46 Gy to the initial target volumes followed by a 24 Gy boost. The primary endpoint was 3-year overall survival (OS), with a predefined threshold of 80 %.
RESULTS: Fifty-seven patients were enrolled. Median follow-up was 6.8 years. Three-year OS was 93.0 % (95 % CI, 82.4-97.3 %), and 5-year OS was 87.6 % (95 % CI, 75.8-93.9 %). Five-year progression-free survival and loco-regional progression-free survival were 77.0 % and 78.8 %, respectively. No recurrences occurred solely within omitted prophylactic nodal regions. Most patients with progression had p16-negative/unknown disease and/or smoking history. Grade ≥ 3 late adverse events were observed in one patient.
CONCLUSIONS: IMRT alone with reduced prophylactic nodal irradiation showed encouraging long-term survival in selected patients with early-stage OPC, with no failures solely within omitted prophylactic nodal regions. However, progression patterns suggest that careful patient selection based on p16/HPV status and smoking history is essential when considering radiotherapy alone.
TRIAL REGISTRATION: UMIN-CTR UMIN000014274.
MATERIALS AND METHODS: JCOG1208 was a prospective, multi-institutional, single-arm study that enrolled patients aged 20-80 years with T1-2 N0-1 M0 OPC of the tonsil, base of tongue, or soft palate according to the UICC 7th edition. Concurrent chemotherapy was not permitted. Patients received two-step adaptive IMRT to 70 Gy in 35 fractions, including 46 Gy to the initial target volumes followed by a 24 Gy boost. The primary endpoint was 3-year overall survival (OS), with a predefined threshold of 80 %.
RESULTS: Fifty-seven patients were enrolled. Median follow-up was 6.8 years. Three-year OS was 93.0 % (95 % CI, 82.4-97.3 %), and 5-year OS was 87.6 % (95 % CI, 75.8-93.9 %). Five-year progression-free survival and loco-regional progression-free survival were 77.0 % and 78.8 %, respectively. No recurrences occurred solely within omitted prophylactic nodal regions. Most patients with progression had p16-negative/unknown disease and/or smoking history. Grade ≥ 3 late adverse events were observed in one patient.
CONCLUSIONS: IMRT alone with reduced prophylactic nodal irradiation showed encouraging long-term survival in selected patients with early-stage OPC, with no failures solely within omitted prophylactic nodal regions. However, progression patterns suggest that careful patient selection based on p16/HPV status and smoking history is essential when considering radiotherapy alone.
TRIAL REGISTRATION: UMIN-CTR UMIN000014274.