What is it about?
A recent randomized clinical trial (UPGRADE-RT) evaluated whether lowering the radiation dose delivered to elective neck lymph nodes could reduce treatment burden while maintaining cancer control in patients with head and neck cancer. In this correspondence, we discuss the interpretation of the trial results and highlight several issues that should be considered before broadly adopting this reduced-dose strategy in routine clinical practice.
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Why is it important?
Radiotherapy and chemoradiotherapy can cure many patients with head and neck cancer, but they can also cause long-term side effects that affect swallowing, nutrition, and quality of life. Reducing unnecessary radiation exposure is therefore an important goal. However, treatment de-escalation should only be adopted when supported by strong evidence that cancer outcomes are not compromised
Perspectives
As investigators conducting the JCOG1912 trial, we strongly support efforts to reduce treatment-related toxicity in head and neck cancer. At the same time, de-escalation strategies must be supported by robust evidence to ensure that improvements in quality of life are not achieved at the expense of cancer control.
Naomi Kiyota
Kobe University Hospital
Read the Original
This page is a summary of: Caution Needed Before Adopting Reduced-Dose Elective Neck Irradiation in Head and Neck Cancer: A Response to UPGRADE-RT, Journal of Clinical Oncology, July 2025, American Society of Clinical Oncology (ASCO),
DOI: 10.1200/jco-25-00928.
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