Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-13T01:13:29.995Z Has data issue: false hasContentIssue false
  • English
  • Français

IMRT with concomitant boost versus conventional radiation in the setting of sequential chemoradiotherapy for oropharyngeal cancer

Published online by Cambridge University Press:  12 May 2014

Giovanni Franchin ,
Carlo Furlan ,
Emanuela Vaccher ,
Renato Talamini ,
Carlo Gobitti ,
Giuseppe Grando ,
Emilio Minatel ,
Andrea Dassie ,
Mauro Gaetano Trovò  and
Luigi Barzan
Giovanni Franchin
Affiliation:
Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Carlo Furlan*
Affiliation:
Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Emanuela Vaccher
Affiliation:
Division of Medical Oncology A, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Renato Talamini
Affiliation:
Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Carlo Gobitti
Affiliation:
Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Giuseppe Grando
Affiliation:
Head and Neck Division, General Hospital ‘S. Maria degli Angeli’, Pordenone, Italy
Emilio Minatel
Affiliation:
Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Andrea Dassie
Affiliation:
Physics Department, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Mauro Gaetano Trovò
Affiliation:
Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
Luigi Barzan
Affiliation:
Head and Neck Division, General Hospital ‘S. Maria degli Angeli’, Pordenone, Italy
*
Correspondence to: Carlo Furlan, Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS, Via Franco Gallini, 2, 33081 Aviano, Italy. Tel: +39-0434-659081; Email [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The aim of this study was to assess the efficacy of IMRT with concomitant boost simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) compared with conventional radiation in the setting of sequential chemoradiotherapy (induction chemoradiotherapy(ICRT)) for patients with advanced oropharynx cancer (OPC).

Materials and methods

A single-institutional retrospective review was conducted on 84 patients (conventional radiation, n = 36; SIB-IMRT, n = 48) with stage III and IV OPC, who underwent definitive ICRT from 2002 to 2012. The study endpoints included overall survival (OS) and locoregional control (LRC).

Results

The median follow-up of the matched cohorts resulted similar (30 months for 3D-radiation technique versus 37 months for IMRT), and baseline characteristics were generally balanced between the two groups. However, patients managed with conventional radiation were less likely to have positron emission tomography-computed tomography (PET-CT) for staging and to receive induction chemotherapy with TPF. A multivariate Cox proportional hazard model showed that OS and LRC were associated with several known prognostic factors, along with radiation modality (SIB-IMRT versus conventional radiation, hazard ratio 0·27, p = 0·004; hazard ratio 0·31, p = 0·006; for OS and LRC, respectively).

Conclusions

The adoption of SIB-IMRT versus conventional radiation may produce a clinical benefit in OS and LRC among patients receiving ICRT for advanced OPC.

Keywords

advanced oropharynx cancercombined modality therapyconcomitant boostIMRTsequential therapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 4 , December 2014 , pp. 418 - 427
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Chaturvedi, A K, Engels, E A, Pfeiffer, R M et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011; 29 (32): 4294–4301.CrossRefGoogle ScholarPubMed
2. Pignon, J P, Bourhis, J, Domenge, C, Designé, L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000; 355 (9208): 949–955.Google Scholar
3. Pignon, J P, le Maitre, A, Bourhis, J, MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update. Int J Radiat Oncol Biol Phys 2007; 69 (suppl): S112–114.CrossRefGoogle ScholarPubMed
4. Vergeer, M R, Doornaert, P A, Rietveld, D H, Leemans, C R, Slotman, B J, Langendijk, J A. Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: results of a nonrandomized prospective study using a standardized follow-up program. Int J Radiat Oncol Biol Phys 2009; 74 (1): 1–8.Google Scholar
5. Nutting, C M, Morden, J P, Harrington, K J et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 2011; 12 (2): 127–136.CrossRefGoogle ScholarPubMed
6. Tribius, S, Bergelt, C. Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck cancer: is there a worthwhile quality of life gain? Cancer Treat Rev 2011; 37 (7): 511–519.CrossRefGoogle Scholar
7. Yong, H J, Beca, J, O'Sullivan, B et al. Cost-effectiveness of intensity-modulated radiotherapy in oropharyngeal cancer. Clin Oncol (R Coll Radiol) 2012; 24 (7): 532–538.Google Scholar
8. McBride, S M, Parambi, R J, Jang, J W, Goldsmith, T, Busse, P M, Chan, A W. Head Neck. 2014; 36 (4): 492–498.Google Scholar
9. Clavel, S, Nguyen, D H, Fortin, B et al. Simultaneous integrated boost using intensity-modulated radiotherapy compared with conventional radiotherapy in patients treated with concurrent carboplatin and 5-fluorouracil for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2012; 82 (2): 582–589.Google Scholar
10. Staffurth, J. Radiotherapy Development Board. A review of the clinical evidence for intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol) 2010; 22 (8): 643–657.Google Scholar
11. Lee, N Y, de Arruda, F F, Puri, D R et al. A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2006; 66 (4): 966–974.Google Scholar
12. Rothschild, S, Studer, G, Seifert, B et al. PET/CT staging followed by intensity-modulated radiotherapy (IMRT) improves treatment outcome of locally advanced pharyngeal carcinoma: a matched-pair comparison. Radiat Oncol 2007; 2: 22.CrossRefGoogle ScholarPubMed
13. Hodge, C W, Bentzen, S M, Wong, G et al. Are we influencing outcome in oropharynx cancer with intensity-modulated radiotherapy? An inter-era comparison. Int J Radiat Oncol Biol Phys 2007; 69 (4): 1032–1041.Google Scholar
14. Pfister, D G, Ang, K, Brockstein, B et al. National comprehensive cancer network. NCCN practice guidelines for head and neck cancers. Oncology 2000; 14 (11A): 163–194.Google Scholar
15. Edge, S B, Byrd, D R, Compton, C C, Fritz, A G, Greene, F L, Trotti, A. (ed.). American Joint Committee Cancer staging manual, 7th edition. New York, NY: Springer, 2010.Google Scholar
16. National Cancer Institute: common terminology criteria for adverse events version 3.0 (CTCAE). http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf. Accessed on 9 August 2006.Google Scholar
17. Orlandi, E, Palazzi, M, Pignoli, E, Fallai, C, Giostra, A, Olmi, P. Radiobiological basis and clinical results of the simultaneous integrated boost (SIB) in intensity modulated radiotherapy (IMRT) for head and neck cancer: a review. Crit Rev Oncol Hematol 2010; 73 (2): 111–125.CrossRefGoogle ScholarPubMed
18. Posner, M R, Lorch, J H, Goloubeva, O et al. Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial. Ann Oncol 2011; 22 (5): 1071–1077.Google Scholar
19. Kader, H A, Mydin, A R, Wilson, M et al. Treatment outcomes of locally advanced oropharyngeal cancer: a comparison between combined modality radio-chemotherapy and two variants of single modality altered fractionation radiotherapy. Int J Radiat Oncol Biol Phys 2011; 80 (4): 1030–1036.CrossRefGoogle ScholarPubMed
20. van de Water, T A, Bijl, H P, Schilstra, C, Pijls-Johannesma, M, Langendijk, J A. The potential benefit of radiotherapy with protons in head and neck cancer with respect to normal tissue sparing: a systematic review of literature. Oncologist 2011; 16 (3): 366–377.Google Scholar
21. van de Water, T A, Lomax, A J, Bijl, H P, Schilstra, C, Hug, E B, Langendijk, J A. Using a reduced spot size for intensity-modulated proton therapy potentially improves salivary gland-sparing in oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2012; 82 (2): 313–319.Google Scholar
22. Keil, F, Selzer, E, Berghold, A et al. Induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil followed by radiotherapy with cetuximab for locally advanced squamous cell carcinoma of the head and neck. Eur J Cancer 2013; 49 (2): 352–359.CrossRefGoogle ScholarPubMed
23. Cohen, E E W, Karrison, T, Kocherginsky, M et al. DeCIDE. A phase III randomized trial of docetaxel (D), cisplatin (P), 5-fluorouracil (F) (TPF) induction chemotherapy (IC) in patients with N2/N3 locally advanced squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2012; 30 (suppl 15): 5500.Google Scholar
24. Haddad, R I, Rabinowits, G, Tishler, R B et al. The PARADIGM trial. A phase III study comparing sequential therapy (ST) to concurrent chemoradiotherapy (CRT) in locally advanced head and neck cancer (LANHC). J Clin Oncol 2012; 30 (suppl 15): 5501.CrossRefGoogle Scholar