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Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy

Effect on outcome and toxicity in locally advanced head and neck cancer

Intensitätsmodulierte Strahlentherapie versus Parotis schonende 3-D- konformale Strahlentherapie

Effektivität und Toxizität der Behandlung beim lokal fortgeschrittenen Kopf-Hals-Karzinoms

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Abstract

Background and purpose

Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT).

Material and methods

A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan–Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system.

Results

Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis ≥ grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia ≥ grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia ≥ grade 2 in the IMRT group although differences failed to reach statistical significance.

Conclusion

The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique.

Zusammenfassung

Hintergrund und Ziel

Die intensitätsmodulierte Strahlentherapie (IMRT) hat sich in den letzten Jahren als Standard in der Therapie der lokal fortgeschrittenen Plattenepithelkarzinome des Kopf-Hals-Bereichs etablieren können. Das Ziel dieser retrospektiven Studie ist es, die Effektivität und Toxizität der intensitätsmodulierten Radiotherapie (IMRT) mit einer, die Parotis schonenden, 3-D-konformalen Strahlentherapie (3DCRT) bei der Behandlung des lokal fortgeschrittenen Kopf-Hals-Karzinoms zu vergleichen.

Material und Methodik

Insgesamt wurden 245 Patienten mit einem Plattenepithelkarzinom des Kopf-Hals-Bereichs im Stadium III und IV, die zwischen Januar 2003 und Dezember 2010 mit einer primären Strahlentherapie behandelt wurden, in die Studie aufgenommen. Von diesen wurden 135 Patienten mit 3DCRT behandelt, 110 Patienten mit IMRT. Die beiden Gruppen wurden bezüglich akuter und später Nebenwirkungen, lokoregionaler Tumorkontrollrate (LRC) sowie Überlebensrate (OS) miteinander verglichen. Die onkologischen Parameter wurden nach Kaplan-Meier berechnet und mittels Log-Rank-Test verglichen. Die akute Toxizität wurde anhand CTCAE v3.0 evaluiert und die Spättoxizität anhand der RTOG/EORTC-Spättoxizitätskriterien beurteilt.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 35 Monate in der IMRT-Gruppe und 68 Monate in der 3DCRT-Gruppe. Es fand sich kein signifikanter Unterschied bei der lokoregionalen Tumorkontrollrate und der Überlebensrate nach 3 Jahren zwischen der IMRT-Gruppe und der 3DCRT-Gruppe. Akute Mukositis ≥ Grad 3 wurde in der IMRT-Gruppe signifikant weniger beobachtet (32% vs. 44%; p = 0,03). Späte Xerostomie ≥ Grad 2 trat signifikant seltener in der IMRT-Gruppe im Vergleich zu der 3DCRT-Gruppe auf (23% vs. 68%; p < 0,001). In der IMRT-Gruppe waren nach 24 Monaten weniger späte Dysphagien aufgetreten, gleichwohl war dies nicht statistisch signifikant.

Schlussfolgerung

Die Einführung der IMRT als Standardtherapie bei der Behandlung des lokal fortgeschrittenen Kopf-Hals-Karzinoms hat keinen negativen Einfluss auf den onkologische Erfolg der Behandlung, gleichwohl kommt es zu einer deutlichen Verminderung der akuten und späten Nebenwirkungen verglichen mit der, die Parotis schonenden, 3-D-konformalen Strahlentherapie (3DCRT).

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Acknowledgment

Maarten Lambrecht is a research assistant (aspirant) of the Research Foundation—Flanders (FWO). A special thanks to Pascal Wolter, MD and Isabelle Kindts, MD for the help in translating the abstract.

Conflict of interest notification

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Leuvens Kankerinstituut, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    M. Lambrecht M.D., D. Nevens M.D. & S. Nuyts M.D. Ph.D.

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  1. M. Lambrecht M.D.
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  2. D. Nevens M.D.
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  3. S. Nuyts M.D. Ph.D.
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Lambrecht, M., Nevens, D. & Nuyts, S. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Strahlenther Onkol 189, 223–229 (2013). https://doi.org/10.1007/s00066-012-0289-7

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  • DOI: https://doi.org/10.1007/s00066-012-0289-7

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