A prospective, comparative analysis of acute toxicity profile between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in locally advanced head and neck cancer patients

Abstract

IntroductionThe advances of modern radiotherapy have emerged with the development of conformal radiotherapy techniques, such as the three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). We prospectively compared acute toxicities and treatment-compliance between IMRT and 3DCRT in patients with locally advanced head and neck carcinoma. Method80 patients were enrolled in this comparative prospective non-randomized study. Inclusion criteria were patients with locally advanced carcinoma of hypopharynx, oropharynx and larynx. 40 patients were treated with IMRT and 40 patients with 3DCRT to dose of 70 Gy in 35 fractions, along with concurrent cisplatin weekly chemotherapy. All patients were assessed weekly during chemoradiotherapy treatment and after 3 months of the treatment. Results15 patients (38.4%) versus 8 patients (20.51%) developed grade 3 mucositis in the 3DCRT and IMRT group respectively (p= <0.001). At three months post chemo-radiotherapy treatment, 17 patients (43.6%) versus 7 patients (17.9%) had grade 2 dysphagia in 3DCRT and IMRT group respectively (p = 0.029). At three months post radiotherapy, grade 3 xerostomia was seen in 3 patients (7.6%) in 3DCRT group versus no patient (0%) in IMRT group (p = 0.006). IMRT group had lower incidence of grade 3 dermatitis (p = 0.043), weight loss of the patients during the treatment (p = 0.126), lesser requirement of nasogastric intubation (p = 0.003) and better treatment-compliance (p = 0.336) compared to 3DCRT. ConclusionIMRT reduced the incidence of severe mucositis, dysphagia, xerostomia, weight-loss of the patients, requirements for nasogastric tube and it improved the treatment-compliance compared to 3DCRT in locally advanced head neck cancer patients treated by chemo-radiotherapy.