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

Jun Won Kim, Jae Ho Cho, Ki Chang Keum, Joo Ho Kim, Gwi Eon Kim, Jong Young Lee, Soo Kon Kim, Chang Geol Lee

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 (D5/D95). 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.

Original languageEnglish
Article numberhys169
Pages (from-to)1152-1160
Number of pages9
JournalJapanese Journal of Clinical Oncology
Volume42
Issue number12
DOIs
Publication statusPublished - 2012 Dec 1

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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