Intensity-modulated radiotherapy with simultaneous integrated boost for locoregionally advanced nasopharyngeal carcinoma

Abstract

ObjectiveTo compare the treatment outcomes of intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) alone to concurrent chemoradiotherapy (CCRT) for locoregionally advanced nasopharyngeal carcinoma (NPC).MethodsFrom November 2001 to December 2009, 333 patients with pathologically diagnosed, locoregionally advanced NPC were treated by IMRT-SIB with or without weekly cisplatin concurrent chemotherapy at our institute. Among them, 62 patients received neo- or adjuvant chemotherapy or molecular target drugs were excluded from this analysis. There were 129 patients received IMRT-SIB alone, and 142 patients received IMRT-SIB with weekly cisplatin 30 mg/m2 for 7 weeks. The radiotherapy protocol was identical for each group.ResultsThere were no significant differences in survival between CCRT and IMRT-SIB group in terms of gender, T/N classifications and concurrent chemoradiotherapy. The 5-year local control (LC), overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) for the entire group were 87.0%, 79.4%, 69.7 and 83.3%, respectively. The LC, OS, DFS and DMFS for CCRT and IMRT-SIB alone groups were 80.6% vs. 90.8% (P = 0.10), 71.7% vs. 83.2% (P = 0.201), 63.9% vs. 74.6% (P = 0.07), and 79.6% vs. 86.0% (P = 0.27), respectively.ConclusionCompared to CCRT, IMRT-SIB alone had demonstrated similar disease LC, OS, DFS and DMFS in locoregionally advanced NPC. Careful radiation target volume design and simultaneous integrated boost may play a role that overrides the benefit from concurrent chemotherapy. Further investigation with randomized study is necessary to determine whether IMRT-SIB alone can achieve similar outcomes of concurrent chemoradiotherapy.

Concurrent chemoradiotherapy by simultaneously integrated boost volumetric‐modulated arc therapy for nasopharyngeal carcinoma‐toxicity/quality of life and survival

“…The acute toxicity with grade 3 or more was low in our patients and no treatment interruption of SIB‐VMAT was observed during CCRT course. Grade 3 mucositis was experienced in 10.7% of our patients, which is lower than the results (16.0%‐34.9%) in NPC patients treated by CCRT with SIB‐IMRT . With a primary focus on sparing the parotids, many clinical studies have proved the significant reduction of xerostomia after IMRT relative to the conventional technique .…”

“…IMRT or VMAT may be applied in the conventional fractionation scheme with sequential shrinkage phases, or a newer fractionation scheme, known as simultaneously integrated boost (SIB), which offers the opportunity to treat different targets simultaneously at different dose levels. The application with SIB planning, compared to sequential planning, has the advantages of providing higher dose per fraction to the tumor with shorter overall treatment time and has become a popular fractionation strategy in treating NPC, especially for those with locally advanced tumor . As far as we know, a comprehensive outcome analysis for NPC patients treated by CCRT with the technique of SIB‐VMAT was scarcely reported in the literature.…”

“…The application with SIB planning, compared to sequential planning, has the advantages of providing higher dose per fraction to the tumor with shorter overall treatment time and has become a popular fractionation strategy in treating NPC, especially for those with locally advanced tumor. 8,9 As far as we know, a comprehensive outcome analysis for NPC patients treated by CCRT with the technique of SIB-VMAT was scarcely reported in the literature. In this study, in addition to the conventional treatment endpoints regarding the acute/late toxicities, tumor control, and patient survival, moreover, the longitudinal changes of patients' QOL following the treatment would be investigated.…”

The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT) with or without chemotherapy

“…Early results from this trial suggest that ACT may not be beneficial in this group of patients. A recent retrospective study by Yi et al (2014) found the outcomes of advanced NPC treated by cisplatin-based CCRT alone were poorer among patients treated by radical IMRT; the OS, disease-free survival (DFS) and DMFS rates were 71.7, 63.9 and 79.6%, respectively. No significant differences in survival between CCRT and radiotherapy alone in patients with stage III-IVb disease treated by radical IMRT have been observed.…”

Systemic chemotherapy followed by locoregional definitive intensity-modulated radiation therapy yields prolonged survival in nasopharyngeal carcinoma patients with distant metastasis at initial diagnosis

“…Thirty (73 %) patients After the completion of chemotherapy, patients underwent radiation therapy to the head and neck region performed uniformly with IMRT. Details regarding the radiation techniques have been previously reported [14,15]. Briefly, the total dose to the primary gross tumor (GTVnx), the involved cervical lymph nodes (GTVnd), the subclinical regions at high risk of involvement (PTV1) and the low-risk lymph nodal regions (PTV2) were 70-76, 70, 60 and 50-54 Gy, respectively.…”