Top

Published in:

01-08-2014 | Radiotherapy

Conventional 2D (2DRT) and 3D conformal radiotherapy (3DCRT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal cancer treatment

Authors: Francesco Moretto, Monica Rampino, Fernando Munoz, Maria Grazia Ruo Redda, Alessia Reali, Vittoria Balcet, Serena Badellino, Cristina Piva, Marina Schena, Mario Airoldi, Oliviero Ostellino, Giancarlo Pecorari, Riccardo Ragona, Umberto Ricardi

Published in: La radiologia medica | Issue 8/2014

Abstract

Purpose

Nasopharyngeal carcinoma represents a distinct entity as compared to other head and neck tumours. Radio-chemotherapy is the treatment of first choice in non-metastatic disease. Intensity-modulated radiation therapy (IMRT) allows the sparing of parotid glands, improving the toxicity profile. The aim of this study was to compare the results obtained with IMRT with those obtained with conventional 2D (2DRT) and 3D conformal radiation therapy (3DCRT) in terms of tumour control, survival, acute and late toxicity.

Materials and methods

We reviewed the clinical records of 52 patients with histologically proven carcinoma of the nasopharynx (stage I–IVB according to the 2002 American Joint Committee on Cancer staging system) treated with curative intent between January 2003 and August 2011: 26 patients were treated with 2D or 3D technique (arm A) and 26 with IMRT technique (arm B) with simultaneous integrated boost. Fifty patients (96 %) received chemotherapy. Local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), acute and late toxicity were retrospectively evaluated.

Results

After a median follow-up of 37.6 months (69 months in arm A and 23 months in arm B), 69 % of patients were alive and disease-free, 10 % were alive with disease and 21 % died of disease, with an OS of 81 % at 2 years and 79 % at 5 years, a LC rate of 88 % at 2 years and 78 % at 5 years, a LRC rate of 80 % at 2 years and 73 % at 5 years and a DFS of 74 % at 2 years and 65 % at 5 years, with no statistically significant differences between IMRT and 2DRT/3DCRT. In multivariate analysis, the TNM stage and the volume treated at high dose correlated with DFS. No factor was found to be related to OS. Chronic toxicity was not statistically different in the two study groups and in particular ≥G2 xerostomia rates were 67 and 41 % in arm A and B, respectively (p = 0.10).

Conclusions

The findings of this study confirm that IMRT associated with chemotherapy, even with moderately hypofractionated regimens, allows good disease control with better results in terms of late xerostomia, although without statistically significant differences compared to 2DRT and 3DCRT. The hypothesis of an impact of IMRT on survival has yet to be confirmed.

Vokes EE, Liebowitz DN, Weichselbaum RR (1997) Nasopharyngeal carcinoma. Lancet 350:1087–1091PubMedCrossRef

Ali H, Al-Sarraf M (2000) Chemotherapy in advanced nasopharyngeal cancer. Oncology (Huntingt) 14:1223–1230

Chen QY, Wen YF, Guo L et al (2011) Concurrent chemoradiotherapy vs. radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst 103:1761–1770PubMedCrossRef

Lee N, Harris J, Garden AS et al (2009) Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. J Clin Oncol 27:3684–3690PubMedCentralPubMedCrossRef

Al-Sarraf M, Le Blanc M, Shanker PG et al (1998) Chemo-radiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized intergroup study 0099. J Clin Oncol 16:1310–1317PubMed

Al-Sarraf M, LeBlanc M, Giri PG et al (2001) Superiority of 5-years survival with chemoradiotherapy vs. radiotherapy in patients with locally advanced nasopharyngeal cancer. Intergroup 0099 phase III study: final report. Proc Am Soc Clin Oncol 20 (abstract 905)

Lin JC, Jan JS, Hsu CY et al (2003) Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol 21:631–637PubMedCrossRef

Chen Y, Liu MZ, Liang SB et al (2008) Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiation alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic region of China. Int J Radiat Oncol Biol Phys 71:1356PubMedCrossRef

Wee J, Tan EH, Tai BC et al (2005) Randomized trial of radiotherapy versus concurrent chemoradiotherapy in patients with American joint committee on cancer/international union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol 23:6966CrossRef

10.

Langendijk JA, Leemans R, Buter J et al (2004) The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol 22:4604–4612PubMedCrossRef

11.

Pow EH, Kwong DL, McMillan AS et al (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66:981–991PubMedCrossRef

12.

Kam MK, Leung SF, Zee B et al (2007) Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol 25:4873–4879PubMedCrossRef

13.

Chan ATC, Teo PML, Ngan RK et al (2002) Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol 20:2038–2044PubMedCrossRef

14.

Chan ATC, Teo PML, Leung TW et al (1995) A prospective randomized study of chemotherapy adjunctive to definitive radiotherapy in advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 33:569–577PubMedCrossRef

15.

Chen L, Hu CS, Chen XZ et al (2012) Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol 13:163–171PubMedCrossRef

16.

Palazzi M, Orlandi E et al (2009) Further improvement in outcomes of nasopharyngeal carcinoma with optimized radiotherapy and induction plus concomitant chemotherapy: an update of the Milan experience. Int J Radiat Oncol Biol Phys 74:774–780PubMedCrossRef

17.

Tonoli S, Magrini SM, Costa L et al (2012) A benchmark study on 883 nasopharyngeal cancer patients treated in two Italian Centres from 1977 to 2000. Part I: evolving technical choices and survival. Radiol Med 117:690–714PubMedCrossRef

18.

Kam MKM, Teo PML, Chau RMC et al (2004) Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: The Hong Kong experience. Int J Radiat Oncol Biol Phys 60:1440–1450PubMedCrossRef

19.

Lee N, Xia P, Quivey J et al (2002) Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 53:12–22PubMedCrossRef

20.

Wolden SL, Chen WC, Pfister DG et al (2006) Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the memorial sloan-kettering experience. Int J Radiat Oncol Biol Phys 64:57–62PubMedCrossRef

21.

Hareyama M, Sakata K, Shirato H et al (2002) A prospective randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in advanced nasopharyngeal carcinoma. Cancer 94:2217–2223PubMedCrossRef

22.

Lee AW, Yau TK, Wong DH et al (2005) Treatment of stage IV (A–B) nasopharyngeal carcinoma by induction-concurrent chemoradiotherapy and accelerated fractionation. Int J Radiat Oncol Biol Phys 63:1331–1338PubMedCrossRef

23.

Rischin D, Corry J, Smith J et al (2002) Excellent disease control and survival in patients with advanced nasopharyngeal cancer treated with chemoradiation. J Clin Oncol 20:1845PubMedCrossRef

24.

Lee AW, Lau KY, Hung WM et al (2008) Potential improvement of tumor control probability by induction chemotherapy for advanced nasopharyngeal carcinoma. Radiother Oncol 87:204–210PubMedCrossRef

25.

Chua DT, Sham JS, Choy D et al (1998) Preliminary report of the Asian-Oceanian clinical oncology association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Cancer 83:2270–2283PubMedCrossRef

26.

Al-Amro A, Al-Rajhi N, Khafaga Y et al (2005) Neoadjuvant chemotherapy followed by concurrent chemo-radiation therapy in locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 62:508–513PubMedCrossRef

27.

Ma J, Mai HQ, Hong MH et al (2001) Results of a prospective randomized trial comparing neoadiuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 19:1350–1357PubMed

28.

Hui EP, Ma BB, Leung SF et al (2009) Randomized phase II trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma. J Clin Oncol 27:242–249PubMedCrossRef

29.

Lin S, Lu JJ, Han L et al (2010) Sequential chemotherapy and intensity modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: Experience of 370 consecutive cases. BMC cancer 10:39PubMedCentralPubMedCrossRef

30.

Vermorken JB, Remenar E et al (2007) Cisplatin, fluorouracil and docetaxel in unresectable head and neck cancer. N Engl J Med 357:1695–1704PubMedCrossRef

31.

Lorch JH, Goloubeva O, Haddad RI et al (2011) Induction chemotherapy with cisplatin and fluorouracil alone or in combination with docetaxel in locally advanced squamous-cell cancer of the head and neck: long term results of the TAX 324 randomized phase III trial. Lancet Oncol 12:153–159PubMedCrossRef

32.

Lee AW, Poon YF, Foo W et al (1992) Retrospective analysis of 5,037 patients with nasopharyngeal carcinoma treated during 1976–1985: overall survival and patterns of failure. Int J Radiat Oncol Biol Phys 23:261–270PubMedCrossRef

33.

Geara FB, Sanguineti G, Tucker SL et al (1997) Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of distant metastasis and survival. Radiother Oncol 43:53–61PubMedCrossRef

34.

Lee AWM, Sze WM, Au JSK et al (2005) Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys 61:1107–1116PubMedCrossRef

35.

Bucci M, Xia P, Lee N et al (2004) Intensity-modulated radiation therapy for carcinoma of the nasopharynx: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 60:S317–S318CrossRef

36.

Lee S, Back GM, Yi BY et al (2006) Preliminary results of a phase I/II study of simultaneous modulated accelerated radiotherapy for nondisseminated nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 65:152–160PubMedCrossRef

37.

Wu S, Xie C, Jin X, Zhang P (2006) Simultaneous modulated accelerated radiation therapy in the treatment of nasopharyngeal cancer: a local center’s experience. Int J Radiat Oncol Biol Phys 66:S40–S46CrossRef

38.

Koom WS, Kim TH, Shin KH et al (2008) SMART (simultaneous modulated accelerated radiotherapy) for locally advanced nasopharyngeal carcinomas. Head Neck 30:159–169PubMedCrossRef

Title: Conventional 2D (2DRT) and 3D conformal radiotherapy (3DCRT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal cancer treatment
Authors: Francesco Moretto
Monica Rampino
Fernando Munoz
Maria Grazia Ruo Redda
Alessia Reali
Vittoria Balcet
Serena Badellino
Cristina Piva
Marina Schena
Mario Airoldi
Oliviero Ostellino
Giancarlo Pecorari
Riccardo Ragona
Umberto Ricardi
Publication date: 01-08-2014
Publisher: Springer Milan
Published in: La radiologia medica / Issue 8/2014
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-013-0359-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conventional 2D (2DRT) and 3D conformal radiotherapy (3DCRT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal cancer treatment

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2014

Diffusion-weighted magnetic resonance imaging in the prediction and assessment of chemotherapy outcome in liver metastases

Recurrent glioblastoma multiforme versus radiation injury: a multiparametric 3-T MR approach

Real time evaluation of monolateral clubfoot with sonoelastography

Role of interventional radiology in treating obstetric haemorrhages

Autoimmune pancreatitis: multidetector-row computed tomography (MDCT) and magnetic resonance (MR) findings in the Italian experience

Assessment of dose exposure and image quality in coronary angiography performed by 640-slice CT: a comparison between adaptive iterative and filtered back-projection algorithm by propensity analysis