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Acute toxicity of concomitant boost radiation therapy by volumetric-modulated arc therapy in head and neck cancers

Published online by Cambridge University Press:  17 August 2017

Kannan Perisamy ,
Ashutosh Mukherji ,
Saravanan Kandasamy  and
K. Sathyanarayan Reddy
Kannan Perisamy
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Ashutosh Mukherji*
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Saravanan Kandasamy
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
K. Sathyanarayan Reddy
Affiliation:
Department of Oncology, Mahatma Gandhi Medical College and Research Centre, Puducherry, India
*
Correspondence to: Dr Ashutosh Mukherji, Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry 605006, India. Tel: 09 489 146 747. E-mail: [email protected]
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Abstract

Introduction

Volumetric-modulated arc therapy (VMAT) is an advanced form of intensity-modulated radiation therapy that reduces treatment time without compromising plan quality. This study assessed acute toxicities in patients having carcinomas of oropharynx, larynx and hypopharynx treated with concomitant boost radiation therapy by VMAT.

Materials and methods

In this study, 30 patients of stages II–IVA disease were treated with concomitant boost radiation therapy using VMAT and those with stages III and IV also received concurrent chemotherapy with cisplatin 100 mg/m2 weekly thrice for two cycles. The total dose was 68·4 Gy/40 fractions/5.5 weeks (1·8 Gy/fraction/day to the large field for 28 fractions +1·5 Gy/fraction/day to boost field for the last 12 days of treatment). Radiation Therapy Oncology Group acute radiation morbidity scoring criteria was used to grade acute effects.

Results

All patients completed scheduled treatment with median duration of 44 days. No grade 4 skin and mucosal toxicities were observed; grade 3 skin and mucosal toxicities seen in six (20%) and eight (26·67%) patients, respectively; grade 3 dysphagia and laryngeal toxicity in eight (26·67%) and three (10%) patients, respectively; two patients had grade 4 laryngeal toxicity. No grade 3 or grade 4 haematological toxicities were seen.

Conclusion

VMAT-based concomitant boost radiation therapy allows for dose escalation with good patient tolerance by limiting acute toxicities.

Keywords

acute chemo-radiation toxicitiesaltered fractionationconcomitant boost radiation therapy with volumetric arc IMRThead and neck cancersvolumetric arc therapy in head and cancers
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 4 , December 2017 , pp. 423 - 430
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Copyright
© Cambridge University Press 2017 

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References

1. Vokes, E E, Weichselbaum, R R, Lippman, S M, Hong, W K. Head and neck cancer. N Engl J Med 1993; 328 (3): 184–194.Google Scholar
2. Fowler, J F, Lindstrom, M J. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 1992; 23 (2): 457–467.Google Scholar
3. Withers, H R, Taylor, J M, Maciejewski, B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988; 27 (2): 131–146.Google Scholar
4. Fu, K K, Pajak, T F, Trotti, A et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000; 48 (1): 7–16.Google Scholar
5. Ghoshal, S, Goda, J S, Mallick, I, Kehwar, T S, Sharma, S C. Concomitant boost radiotherapy compared with conventional radiotherapy in squamous cell carcinoma of the head and neck—a phase III trial from a single institution in India. Clin Oncol (R Coll Radiol ) 2008; 20 (3): 212–220.Google Scholar
6. Srivastava, K. Concomitant boost radiotherapy vs conventional radiotherapy in advanced oral cavity and oropharynx cancers. Indian J Radiol Imaging 2001; 11: 127–130.Google Scholar
7. Eisbruch, A, Marsh, L H, Martel, M K et al. Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing. Int J Radiat Oncol Biol Phys 1998; 41 (3): 559–568.Google Scholar
8. Eisbruch, A, Ten Haken, R K, Kim, H M, Marsh, L H, Ship, J A. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999; 45 (3): 577–587.CrossRefGoogle ScholarPubMed
9. Wu, Q, Manning, M, Schmidt-Ullrich, R, Mohan, R. The potential for sparing of parotids and escalation of biologically effective dose with intensity-modulated radiation treatments of head and neck cancers: a treatment design study. Int J Radiat Oncol Biol Phys 2000; 46 (1): 195–205.Google Scholar
10. Cox, JD, Stetz, J, Pajak, TF et al. Toxicity criteria of Radiation Therapy Oncology Group (RTOG) and European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341–1346.CrossRefGoogle ScholarPubMed
11. Wolden, S L, Zelefsky, M J, Kraus, D H et al. Accelerated concomitant boost radiotherapy and chemotherapy for advanced nasopharyngeal carcinoma. J Clin Oncol 2001; 19 (4): 1105–1110.Google Scholar
12. Otto, K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008; 35 (1): 310–317.Google Scholar
13. Vanetti, E, Clivio, A, Nicolini, G et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009; 92 (1): 111–117.Google Scholar
14. Ang, K K, Harris, J, Garden, A S et al. Concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: Radiation Therapy Oncology Group phase II trial 99-14. J Clin Oncol 2005; 23 (13): 3008–3015.Google Scholar
15. Schoenfeld, G O, Amdur, R J, Morris, C G, Li, J G, Hinerman, R W, Mendenhall, W M. Patterns of failure and toxicity after intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2008; 71 (2): 377–385.Google Scholar
16. Monroe, A T, Young, J A, Huff, J D, Ernster, J A, White, G A, Peddada, A V. Accelerated fractionation head and neck intensity-modulated radiation therapy and concurrent chemotherapy in the community setting: safety and efficacy considerations. Head Neck 2009; 31 (9): 1144–1151.Google Scholar
17. Kubes, J, Cvek, J, Vondracek, V, Pala, M, Feltl, D. Accelerated radiotherapy with concomitant boost technique (69·5 Gy/5 weeks): an alternative in the treatment of locally advanced head and neck cancer. Strahlenther Onkol 2011; 187 (10): 651–655.Google Scholar
18. Allal, A S, Taussky, D, Mach, N, Becker, M, Bieri, S, Dulguerov, P. Can concomitant-boost accelerated radiotherapy be adopted as routine treatment for head-and-neck cancers? A 10-year single-institution experience. Int J Radiat Oncol Biol Phys 2004; 58 (5): 1431–1436.CrossRefGoogle ScholarPubMed
19. Kumar, S, Pandey, M, Lal, P, Rastogi, N, Maria Das, K J, Dimri, K. Concomitant boost radiotherapy with concurrent weekly cisplatin in advanced head and neck cancers: a phase II trial. Radiother Oncol 2005; 75 (2): 186–192.Google Scholar