Abstract
BackgroundTo investigate acute and late toxicities comparing sequential (SEQ-IMRT) versus simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) in nasopharyngeal carcinoma (NPC) patients.MethodsNewly diagnosed stage I-IVB NPC patients were randomized to receive SEQ-IMRT or SIB-IMRT, with or without chemotherapy. SEQ-IMRT consisted of two sequential radiation treatment plans: 2Gy x 25 fractions to low-risk planning target volume (PTV-LR) followed by 2Gy x 10 fractions to high-risk planning target volume (PTV-HR). In contrast, SIB-IMRT consisted of only one treatment plan: 2.12Gy and 1.7Gy x 33 fractions to PTV-HR and PTV-LR, respectively. Toxicities were evaluated according to CTCAE version 4.0.ResultsBetween October 2010 and November 2013, 122 eligible patients were randomized between SEQ-IMRT (54 patients) and SIB-IMRT (68 patients). With median follow-up time of 16.8 months, there was no significant difference in toxicities between the two IMRT techniques. During chemoradiation, the most common grade 3–5 acute toxicities were mucositis (15.4 % vs 13.6 %, SEQ vs SIB, p = 0.788) followed by dysphagia (9.6 % vs 9.1 %, p = 1.000) and xerostomia (9.6 % vs 7.6 %, p = 0.748). During the adjuvant chemotherapy period, 25.6 % and 32.7 % experienced grade 3 weight loss in SEQ-IMRT and SIB-IMRT (p = 0.459). One-year overall survival (OS) and progression-free survival (PFS) were 95.8 % and 95.5 % in SEQ-IMRT and 98 % and 90.2 % in SIB-IMRT, respectively (p = 0.472 for OS and 0.069 for PFS).ConclusionThis randomized, phase II/III trial comparing SIB-IMRT versus SEQ-IMRT in NPC showed no statistically significant difference between both IMRT techniques in terms of acute adverse events. Short-term tumor control and survival outcome were promising.
Highlights
To investigate acute and late toxicities comparing sequential (SEQ-Intensity Modulated Radiation Therapy (IMRT)) versus simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) in nasopharyngeal carcinoma (NPC) patients
Intensity Modulated Radiation Therapy (IMRT), has been developed with the clear advantages of highly conformal and precise coverage with sharp dose gradients shown by many dosimetric studies; it has been impressively embraced in treatment of head and neck tumors [2,3,4]
The objectives of this study are to assess acute and late toxicities comparing SIB-IMRT with SEQ-IMRT and to evaluate clinical outcomes including tumor response, pattern of failure and survival of NPC patients treated with both IMRT techniques
Summary
To investigate acute and late toxicities comparing sequential (SEQ-IMRT) versus simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) in nasopharyngeal carcinoma (NPC) patients. Nasopharyngeal carcinoma (NPC) is one of the most common head and neck tumors and has a good prognosis. The worldwide age-standardized incidence rates of NPC are 1.7 and 0.7 per 100,000 in males and females, respectively, whereas this increases to 6.4 and 2.4 in Southeast Asia. In Thailand, the age-standardized incidence rates of NPC are approximately 3.3 and 1.1 per 100,000 in males and females, respectively [1]. Intensity Modulated Radiation Therapy (IMRT), has been developed with the clear advantages of highly conformal and precise coverage with sharp dose gradients shown by many dosimetric studies; it has been impressively embraced in treatment of head and neck tumors [2,3,4]. The use of IMRT can provide better preservation and faster recovery of parotid gland function [5,6,7]
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