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Throat CancerHPV Infection & Cancer

Shorter Time of Radiation Reduces Side Effects in Some Patients with Throat Cancer Caused by HPV Infection

HPV is a major cause of throat cancer and is rising in the United States. Learn about the symptoms of throat cancer, treatment options, and the benefits of a shorter course of treatment for certain patients.
February 2022 Vol 8 No 1
Wayne Kuznar
Daniel J. Ma, MD

According to the CDC (Centers for Disease Control and Prevention), the human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States, affecting many people who often are not aware of being infected.

HPV is a major cause of throat cancer (cancer in the oropharynx), also known as oropharyngeal cancer, or oral cancer, which is becoming more and more common in the United States. The oropharynx is the middle part of the throat, behind the oral cavity. It includes the back part of the tongue and mouth, the tonsils, and the walls on the side and back of the throat.

The Symptoms of Throat Cancer

Throat or oral cancer that is caused by HPV is often detected late, when the cancer has progressed and is more difficult to treat. Therefore, recognizing symptoms in your mouth or throat is important, and when they are present, be sure to have them checked for possible throat cancer. The main symptoms of throat cancer include:

  • A lump in the throat
  • Swelling in the neck
  • Difficulty swallowing
  • Loss of appetite
  • Rapid weight loss
  • Speech difficulties
  • Weakness and excessive fatigue

Current Treatment & Side Effects

At the 2021 American Society for Radiation Oncology Annual Meeting, researchers from the Mayo Clinic presented the results of a new clinical trial in patients with throat cancer.

“Throat cancer caused by HPV is one of the fastest-growing cancer types in the United States,” said Daniel J. Ma, MD, a radiation oncologist at Mayo Clinic in Rochester, Minnesota, who presented the study results.

Currently, the standard treatment for patients with throat cancer caused by HPV infection involves surgery, followed by 6 weeks of radiation therapy. However, the longer time the radiation is used, the more likely patients are to have treatment

side effects, which can include dry mouth, difficulty swallowing, neck stiffness, and jawbone problems. These side effects can often last a short or a long time.

The results of the new study showed that a shorter time of radiation therapy after surgery for patients with throat cancer caused by HPV leads to excellent control of the cancer, as well as to fewer side effects compared with the current standard treatment.

A New Approach to Therapy

This new approach to treatment is referred to as de-escalated adjuvant radiation therapy. This approach consists of minimally invasive surgery, followed by only 2 weeks of radiation therapy, instead of the current standard of 6 weeks of radiation.

“Our findings suggest that in select patients with HPV-associated oropharynx cancer, a shorter course of treatment compared to the standard of care, yields a similar result,” Dr. Ma said.

The study included 194 patients, and 59% of them had extranodal extension (cancer extending beyond the lymph node capsule into other tissue). The patients were divided into 2 groups—one group of patients received the shorter radiation duration and the second group the standard of care.

At 3 months after treatment, those who received the de-escalated adjuvant radiation therapy after surgery had fewer (1.6%) serious (grade 3 or 4) radiation-related side effects compared with those receiving standard treatment (7.1%).

Furthermore, only a few (1.6%) patients who received the de-escalation radiation required a feeding tube compared with more than a quarter (27.4%) of those who received the 6-week radiation as standard of care.

Based on these results, the Mayo Clinic is now using this shorter course of radiation for patients who are good candidates for this shorter duration of therapy.

Who Can Benefit from Shorter Radiation?

The patients who are candidates for this shorter time of radiation are those whose cancer does not extend beyond the confines of the capsule of a lymph node into other tissues. These patients, whose cancer is limited to that area, can best benefit from this shorter duration of radiation therapy.

The researchers also advised that doctors should exercise caution before using this strategy in patients whose throat cancer extends beyond the lymph nodes.

The Mayo Clinic is planning future clinical trials to test whether combining lower doses of radiation with other treatment strategies, such as proton beam therapy, can further reduce the treatment side effects for patients with throat cancer caused by HPV infection.

Key Points

  • HPV infection is the most common sexually transmitted disease in the United States, affecting many people who often are not aware of having HPV infection
  • HPV infection is a major cause of throat cancer, a type of oral cancer, also known as oropharyngeal cancer
  • Some of the signs of throat cancer include a lump in the throat or neck, difficulties swallowing, loss of appetite or rapid weight loss, and excessive fatigue
  • A new study showed that certain patients with throat cancer can have better results with 2 weeks of radiation therapy instead of the standard 6 weeks
  • The shorter duration of radiation therapy results in fewer side effects and can achieve better outcomes for some patients
  • Only 1.6% of the patients who received shorter radiation needed a feeding tube versus 27.4% of those who received the standard 6-week radiation
  • Patients with throat cancer whose cancer does not spread beyond the lymph nodes are good candidates for the shorter time of radiation therapy

Patient Resources

Centers for Disease Control and Prevention
HPV and Oropharyngeal Cancer
www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm

American Cancer Society
What Are Oral Cavity and Oropharyngeal Cancers?
www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html

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Last modified: June 9, 2022

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