Intensity-modulated radiotherapy in head and neck cancer: Results of the prospective study GORTEC 2004–03

Abstract

Background and purposeIn 2003, the French Authority for Health (HAS) recommended the use of intensity modulated radiotherapy (IMRT) in prospective trial before its routine use. The Oncology and Radiotherapy Group for Head and Neck Cancer (GORTEC) proposed to evaluate prospectively acute and late toxicities, locoregional control and overall survival for patients treated for head and neck cancer (HNC) with IMRT and bilateral neck irradiation. Materials and methodsBetween 2002 and 2008, 208 patients with HNC were treated with IMRT in 8 centres. There were 38 nasopharynx, 117 oropharynx, 25 pharyngo-larynx, 24 oral cavity and 4 unknown primary (28.5% stage I–II and 71% Stage III–IV). Ninety-three patients (46%) had postoperative IMRT and 78 patients (37.5%) received concurrent chemotherapy. The doses were 70Gy to the gross tumour, 66Gy to the high-risk postoperative sites and 50Gy to the subclinical disease. Toxicities were graded according to the RTOG–EORTC scales. ResultsThe median follow-up was 25.3months (range: 0.4–72months). There were 29 local–regional failures: 24 were in-field, three were marginal and one was out-field. The two-year loco-regional control and overall survival were 86% and 86.7%, respectively. At 18months, grade ⩾2 xerostomia was 16.1%. A mean dose to the spared parotid below 28Gy led to significantly less grade ⩾2 xerostomia (8.5% vs 24%) with a relative risk of 1.2 [95% CI: 1.02–1.41, p=0.03]. Grade ⩾2 xerostomia increased by approximately 3% per Gy of mean parotid dose up to 28, Gy then 7% per Gy above 33Gy. ConclusionsIMRT for HN cancer seems to reduce late toxicities without jeopardising local control and overall survival.