Discussion
toxicity, toxicities, LA-SCCHN, deaths, JAVELIN, ototoxicity
ADVERSE EVENTS, DISEASE, OTOTOXICITY
The current CRT regimen for patients with LA-SCCHN is associated with severe late adverse events, decreased QOL, and increased noncancer-related deaths in long-term survivors. The ideal treatment for patients with LA-SCCHN is a modality that is satisfactory for both disease control and the patients’ daily lives. Our trial addresses the question of whether a reduced dose of RT to the prophylactic field without reducing the dose to the target lesion and a concurrent CDDP dose is non-inferior to standard-dose prophylactic RT. Reducing the dose to the prophylactic field is expected to reduce late toxicity by minimizing the irradiation of normal organs.If our study demonstrates that the experimental arm could achieve fewer adverse events without a reduction in efficacy, reduced-dose prophylactic IMRT could be a new standard method of definitive CRT for LA-SCCHN. Numerous clinical studies have investigated the combination strategy of RT and immune checkpoint inhibitors (ICIs). However, the JAVELIN head and neck 100 trial [One significance of this trial is the prospective follow-up for late toxicities, focusing on swallowing function, hearing function, and thyroid functions. Of these, ototoxicity is caused by cochlear toxicity due to CDDP and irradiation, and is irreversible, and is likely to reduce the QOL in patients treated with CRT [