IMRT with simultaneous integrated boost and concurrent chemotherapy for nasopharyngeal cancer: plan evaluation and treatment outcome.

Abstract

OBJECTIVE:

This study evaluated the outcome of intensity-modulated radiation therapy with simultaneous integrated boost and concurrent chemotherapy for nasopharyngeal cancer.

METHODS:

We analyzed 53 consecutive nasopharyngeal cancer patients who received definitive treatment using intensity-modulated radiation therapy with simultaneous integrated boost and cisplatin-based concurrent chemotherapy. Forty-six patients were treated with concurrent chemoradiation and seven patients with induction chemotherapy plus concurrent chemoradiation. The gross tumor (PTV(70)) received 69.96 Gy (2.12 Gy/fraction), high-risk subclinical disease (PTV(60)) received 59.4 Gy (1.8 Gy/fraction) and low-risk subclinical disease (PTV(56)) received 56.1 Gy (1.7 Gy/fraction) in 33 fractions. Twenty-eight patients were treated with step-and-shoot intensity-modulated radiation therapy and 25 patients with helical tomotherapy. Dosimetric parameters were compared between the two modalities.

RESULTS:

The median treatment duration was 49 days (range: 41-65 days). The complete response rate was 92.5%. Three local, two regional, one locoregional and seven distant failures were observed. With the median follow-up of 41 months (range: 8-89 months), the 3- and 5-year local control, locoregional control, disease-free survival and overall survival rates were 91.8 and 91.8%; 87.6 and 87.6%; 77.5 and 70.5%; and 86.4 and 82.1%, respectively. Grade 3 mucositis, dermatitis, leucopenia and grade 4 leucopenia were observed in 10, 1, 2 and 1 patient, respectively. No grade 3 or higher xerostomia occurred. Helical tomotherapy significantly improved dosimetric parameters including the maximum dose, volume receiving >107% of the prescribed dose and uniformity index (D(5)/D(95)).

CONCLUSIONS:

Intensity-modulated radiation therapy with simultaneous integrated boost with concurrent chemotherapy is a safe and effective treatment modality for nasopharyngeal cancer. Helical tomotherapy has a dosimetric advantage over step-and-shoot intensity-modulated radiation therapy in a clinical setting.

• Authors: Jun Won Kim, Jae Ho Cho, Ki Chang Keum, Joo Ho Kim, Gwi Eon Kim, Jong Young Lee, Soo Kon Kim, Chang Geol Lee
• Journal: Japanese journal of clinical oncology (Jpn J Clin Oncol) Vol. 42 Issue 12 Pg. 1152-60 (Dec 2012) ISSN: 1465-3621 [Electronic] England
• PMID: 23077243 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antineoplastic Agents
• Cisplatin

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Agents (administration & dosage)
• Chemoradiotherapy (adverse effects)
• Cisplatin (administration & dosage)
• Female
• Humans
• Japan
• Male
• Middle Aged
• Nasopharyngeal Neoplasms (therapy)
• Radiation Dosage
• Radiotherapy, Intensity-Modulated (adverse effects, methods)
• Safety
• Survival Analysis
• Tissue Distribution