Multicenter randomized trial of reduced elective dose in definitive radiotherapy for head and neck squamous cell carcinoma

Definitive radiotherapy (RT) for head and neck cancer (HNC) has significant long-term toxicity with elective neck irradiation (ENI) as a major contributor. The randomized UPGRADE-RT Trial, af five centers in The Netherlands, evaluated 43 Gy versus control (50 Gy) ENI.The mean normalcy or diet score at 1 year was 91.6 in the dose reduction group and 92.6 in the control group (mean differerence, -1,1; 95% CI -6,5 to 4,4). The 2-year recurrence rate in electively irradiated nodes in the dose reduction group was 4.9%; in the control group this was 4.3%. Exploratory analyses demonstrated less acute dysphagia grade ≥3 and better xerostomia-related quality of life in the dose reduction group. The authors conclude that reduced elective dose is safe in definitive RT for HNC.