Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients

Marta Scorsetti,Armando Santoro,Sara Pentimalli,Luca Cozzi,Piera Navarria,Caterina Bressi,Pietro Mancosu,Antonella Fogliata,Filippo Alongi,Mario Bignardi,Simona Castiglioni

doi:10.1186/1748-717x-5-93

Abstract

BackgroundTo report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology.MethodsDuring 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45Gy and 69.96Gy in 33 fractions (group A); 54.45Gy and 66Gy in 33 fractions (group B) and 55Gy in 25 fractions (group C).ResultsConcerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition.ConclusionsThese preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities.

Highlights

Radiotherapy (RT), with or without chemotherapy, is the primary treatment modality for head and neck cancer patients
Reviews for treatment outcome and major toxicity patterns can be found in Gregoire et al [1], Lee et al [2] and in Popovtzer et al [3] and in references therein
Higher thresholds were observed for sub-mandibular glands in the range of 39 Gy by Murdoc et al [6], while a dose to oral cavity of about 30Gy for late mucositis was reported by Narayan et al [7]

Summary

Introduction

Radiotherapy (RT), with or without chemotherapy, is the primary treatment modality for head and neck cancer patients. In the last decade intensity modulated radiotherapy (IMRT) has gradually assumed a wide role in the management of such diseases. The clear dosimetric benefits were translated to better clinical results in terms of reduction of toxicity, which can improve the quality of Reviews for treatment outcome and major toxicity patterns can be found in Gregoire et al [1], Lee et al [2] and in Popovtzer et al [3] and in references therein. To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology

Methods

Results

Conclusion