Feasibility of Dose-escalated Hypofractionated Chemoradiation in Human Papilloma Virus-negative or Smoking-associated Oropharyngeal Cancer

Research output: Contribution to journalArticle


  • S. Meade
  • A. Hartley
  • M. Robinson
  • J. Cashmore
  • L. Wagstaff
  • J. Babrah
  • P. Sanghera

External organisations

  • Newcastle University
  • Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK.
  • CRUK Clinical Trials Unit, University of Birmingham, Birmingham, UK.
  • Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust


AIMS: Oropharyngeal squamous cell carcinoma (OPSCC) can be divided into favourable and poor prognostic groups by association with human papilloma virus (HPV) and smoking. This study prospectively investigated a dose-intensified schedule in poor/intermediate prognosis OPSCC.

MATERIALS AND METHODS: Patients with p16/HPV-negative or p16-positive N2b OPSCC with a greater than 10 pack-year smoking history were eligible. Patients were planned to receive 64 Gy in 25 fractions with cisplatin. The primary end point was absence of grade 3 mucositis at 3 months.

RESULTS: Fifteen patients were recruited over 14 months. All patients completed a minimum of 2 years of follow-up. All patients completed full-dose radiotherapy within a median treatment time of 32 days (31-35). Grade 3 mucositis was absent in all patients at 3 months. There was one grade 4 toxicity event due to cisplatin (hypokalaemia). Complete response rates at 3 months were 100% and 93% for local disease and lymph nodes, respectively. One patient developed metastatic disease and subsequently died. Overall survival at 2 years was 93% (95% confidence interval 61-99%).

CONCLUSIONS: The schedule of 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with poor and intermediate prognosis OPSCC.


Original languageEnglish
JournalClinical Oncology
Early online date2 Mar 2018
Publication statusPublished - Jun 2018


  • Journal Article, accelerated hypofractionation , human papilloma virus , oropharyngeal cancer , smoking