Personalized neck irradiation guided by sentinel lymph node biopsy in patients with squamous cell carcinoma of the oropharynx, larynx or hypopharynx with a clinically negative neck: (Chemo)radiotherapy to the PRIMary tumor only. Protocol of the PRIMO study

Background

Elective neck irradiation (ENI) is performed in head and neck cancer patients treated with definitive (chemo)radiotherapy. The aim is to eradicate nodal metastases that are not detectable by pretreatment imaging techniques. It is conceivable that personalized neck irradiation can be performed guided by the results of sentinel lymph node biopsy (SLNB). It is expected that ENI can be omitted to one or both sides of the neck in 9 out of 10 patients, resulting in less radiation side effects with better quality of life.

Methods/design

This is a multicenter randomized controlled trial aiming to compare safety and efficacy of treatment with SLNB guided neck irradiation versus standard bilateral ENI in 242 patients with cN0 squamous cell carcinoma of the oropharynx, larynx or hypopharynx for whom bilateral ENI is indicated. Patients randomized to the experimental-arm will undergo SLNB. Based on the histopathologic status of the SLNs, patients will receive no ENI (if all SLNs are negative), unilateral neck irradiation only (if a SLN is positive at one side of the neck) or bilateral neck irradiation (if SLNs are positive at both sides of the neck). Patients randomized to the control arm will not undergo SLNB but will receive standard bilateral ENI. The primary safety endpoint is the number of patients with recurrence in regional lymph nodes within 2 years after treatment. The primary efficacy endpoint is patient reported xerostomia-related quality of life at 6 months after treatment.

Discussion

If this trial demonstrates that the experimental treatment is non-inferior to the standard treatment in terms of regional recurrence and is superior in terms of xerostomia-related quality of life, this will become the new standard of care.

Race Determination and Vegetative Compatibility Grouping of Fusarium oxysporum f. sp. melonis from South Africa

Isolates of Fusarium oxysporum f. sp. melonis (72 total) obtained from 30 fields in 17 melonproducing regions in South Africa were race typed, using differential cvs. CM 17187, Doublon, Perlita, and Topmark, and grouped on the basis of vegetative compatibility. Fifty-four isolates were identified as race 0, eight as race 1, and ten as race 2. Race 0 occurred in 15 of 17 regions, whereas race 1 was sporadically recovered. Race 2 was obtained from only four fields located in one geographic region. Perlita plants (carrying the gene Fom3) inoculated with local isolates of races 0 and 2 and reference isolates of race 0 became stunted, and their leaves became yellow, thickened, and brittle. Using two inoculation methods, similar symptoms were induced by reference and local isolates of race 0 on Perlita seedlings. The results indicated that Fom3 in Perlita confers a tolerant reaction compared with the resistant reaction of gene Fom1 in Doublon and, therefore, should not be used alone in race determination tests. All isolates belonged to vegetative compatibility group 0134, indicating a high degree of genetic homogeneity among the South African F. oxysporum f. sp. melonis population.