TORS down.

Following suit of de-escalation for definitive chemoradiation of HPV(+) oropharyngeal cancer, the large phase 2 ECOG E3311 trial asked whether post-operative radiation can be taken down a notch. Among 353 enrollees receiving transoral robotic surgery (TORS), 206 were found to be pathologically intermediate-risk (close margins, 2-4 + nodes, or ENE ≤1mm) and were then randomized to either the standard adjuvant 60 Gy versus de-escalated 50 Gy. At 2 years, the primary endpoint of progression-free survival was 96% after 60 Gy and 95% after 50 Gy. For comparison, it was 94% for the 34 low-risk patients with no pathologic risk factors who were observed after TORS. It’s worth noting over half of the few recurrences were distant, and the rate of grade 3+ toxicity was reduced from 25 → 15%. TBL: You should feel good enrolling a patient on a phase 3 trial examining TORS + 50 Gy post-op radiation as deescalated therapy for intermediate-risk HPV(+) oropharyngeal cancer. | Ferris, ASCO 2020