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Simultaneous Integrated Boost Intensity‑Modulated Radiotherapy (SIB‑IMRT) in Nasopharyngeal Cancer

Intensitätsmodulierte Radiotherapie mit simultan integriertem Boost (SIB‑IMRT) beim Nasopharynxkarzinom

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Abstract

Purpose:

To assess the efficacy and safety of using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) to treat nasopharyngeal cancer (NPC) in a Caucasian cohort. Outcome was analyzed with respect to dose-volume histogram (DVH) values.

Patients and Methods:

Between 03/2002 and 01/2008, 39 NPC patients underwent SIB-IMRT (37 Caucasians; 31 males; mean age 53 years [16–78 years]). 41% presented with WHO (World Health Organization) type 1 unfavorable histology, 85% with stage III/IV disease. 19 patients had total gross tumor volume (GTV) 16–70 cm3 (mean 36 cm3), while 16 had GTV > 70 cm3 (73–217 cm3; mean 115 cm3). All patients with stage II–IV disease received concomitant cisplatin. The prescribed SIB dose delivered to the planning target volume (PTV) was 70 Gy (2.00 Gy/fraction) in 17, 69.6 Gy (2.11 Gy/fraction) in 19, and 66 Gy (2.20 Gy/fraction) in three patients.

Results:

3-year local relapse-free, nodal relapse-free, distant metastases-free, disease-free rates and overall survival were 86%, 89%, 85%, 72%, and 85% (median follow-up 30 months [8–71 months]). Histology was a significant prognostic factor concerning overall survival, with worst prognosis in WHO type 1 compared to type 2/3 (75% vs. 93%; p = 0.03). There was a trend in favor of WHO type 2/3 regarding local control (74% vs. 94%; p = 0.052). The PTV DVHs showed a slight left shift compared to reported series. Three patients developed grade 3 late effects (xerostomia [n = 2], dysphagia [n = 1], hearing loss [n = 1]).

Conclusion:

In comparison with predominantly Asian NPC IMRT series in the literature, chemo-IMRT in the own Caucasian cohort, characterized by less radioresponsive WHO type 1, was equally effective. Treatment tolerance was excellent.

Zusammenfassung

Ziel:

Es wurden Wirksamkeit und Effektivität der intensitätsmodulierten Radiotherapie mit simultan integriertem Boost (SIBIMRT) beim Nasopharynxkarzinom (NPC) untersucht. Die Resultate werden unter Berücksichtigung der Dosis-Volumen-Histogramm-( DVH-)Werte diskutiert.

Patienten und Methodik:

Zwischen 03/2002 und 01/2008 wurden 39 NPC-Patienten mit SIB-IMRT behandelt (37 Kaukasier; 31 Männer; im Mittel 53 Jahre [16–78 Jahre]). 41% hatten eine ungünstige WHO-Typ-1-Histologie, 85% waren im Stadium III/IV. 19 Patienten wiesen ein Gesamttumorvolumen (GTV) von 16–70 cm3 (Mittelwert 36 cm3), 16 Patienten von > 70 cm3 (73–217 cm3; Mittelwert 115 cm3) auf. Alle Patienten im Stadium II–IV erhielten simultan Cisplatin. Die SIB-Dosis auf das Boost-Planungszielvolumen (PTV) betrug 70 Gy (2,00 Gy/Sitzung) bei 17, 69,6 Gy (2,11 Gy/Sitzung) bei 19 und 66 Gy (2,20 Gy/Sitzung) bei drei Patienten.

Ergebnisse:

Mit einer mittleren Verlaufsbeobachtung von 30 Monaten (8–71 Monate) lagen die 3-Jahres-Uberlebensraten für die Lokal-, Nodal- und Fernkontrolle bei 86%, 89% und 85%, das krankheitsfreie Überleben und das Gesamtüberleben betrugen 72% und 85%. Die Histologie war ein signifikanter prognostischer Faktor hinsichtlich des Gesamtüberlebens, mit ungünstigerer Prognose bei WHO-Typ-1-Histologie im Vergleich zu Typ 2/3 (75% vs. 93%; p = 0,03). Bezüglich der Lokalkontrolle zeigte sich ein Trend zugunsten Typ 2/3 (74% vs. 94%; p = 0,052). In den PTV-DVHs fand sich eine leichtgradige Linksverschiebung im Vergleich zu anderen Serien. Drei Patienten zeigten Grad-3-Spattoxizitat (Xerostomie [n = 2], Dysphagie [n = 1], Schwerhörigkeit [n = 1]).

Schlussfolgerung:

Im Vergleich zur IMRT-Literatur mit großteils asiatischen Populationen fanden sich nach Chemo-IMRT bei der eigenen kaukasischen NPC-Kohorte mit großem Anteil an radioresistentem WHO-Typ 1 ähnliche Resultate. Die Therapietoleranz war ausgezeichnet.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital, Zurich, Switzerland

    Evangelia Peponi, Christoph Glanzmann, Guntram Kunz, Christoph Renner, Katja Tomuschat &  Gabriela Studer

  2. Radiotherapie, USZ, Universitätsspital Zürich, Rämistraße 100, 8091, Zürich, Switzerland

    Gabriela Studer

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  1. Evangelia Peponi
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Correspondence to Gabriela Studer.

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Peponi, E., Glanzmann, C., Kunz, G. et al. Simultaneous Integrated Boost Intensity‑Modulated Radiotherapy (SIB‑IMRT) in Nasopharyngeal Cancer. Strahlenther Onkol 186, 135–142 (2010). https://doi.org/10.1007/s00066-010-2048-y

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