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Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 3/2013

01-03-2013 | Research Article

IMRT: preliminary results in a series of advanced head-and-neck cancer patients

Authors: Antonio Vila Capel, Jorge Vilar Palop, Agustín Pedro Olivé, Alberto Sanchez-Reyes Fernandez, Jordi Vayreda Ribera, Joan Carles Julià Sanahuja, Joaquim Pérez de Olaguer Agustín, Nuria Artola Codina, Luis Miguel Moya Cascant, Esther Rubio Calatayud, Gemma Carrera Domenech

Published in: Clinical and Translational Oncology | Issue 3/2013

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Abstract

Purpose

To determine retrospectively 2–3 year local and regional control (LRC), free-of-disease survival (FDS) and overall survival (OS), as well as summarized toxicities in a group of 31 advanced head-and-neck cancer patients, treated at our institution between 2004 and 2011 with definitive IMRT low-dose concomitant boost, the majority of them with concurrent chemotherapy based on cisplatin. The results are also shown in the sub-group of nasopharyngeal cancer patients (NPC: 15 cases).

Patients and methods

Radiological basal and contrasted CT series, MR-CT or PET/CT fused images in the setup position with immobilization mask were registered in simulation therapy patients. Planed doses were: 70 Gy in primary tumor and positive nodes >1 cm; 63 Gy in high-risk areas of microscopic diseases +10 mm safety margin; and 56 Gy in low risk of diseases regional lymph nodes. Treatment was delivered using a Varian 2100 Clinac with sliding windows IMRT. Spinal cord doses were limited to a strict maximum of 45 Gy, and optimization aimed for mean doses in parotid glands below 26 Gy, especially in the contralateral parotid gland. Online DRR-portal X-ray comparison images were taken every day with a deviation module tolerance ≤3 mm.

Results

The mean follow-up since IMRT was 34 months (interval: 8–89; median 31 months). Median follow-up in living patients was 22 months. The 2-year rate for global LRC was 64 %, for FDS 61 % and OS 77 %. For the NPC group after 2 years, LRC was 73 %, FDS 73 % and OS 93 %. The 3-year rates were similar. Seven patients died as a consequence of local and/or regional progression (mean time 10 months). Relapses were observed in eight patients (26 %), but only seven could be confirmed by biopsy (22.6 %; mean time to relapse: 8.6 months). Global acute mucositis was 61 % and chronic mucositis was shown in six cases which developed xerostomia (19 %) in the first control after IMRT, but 1 year later it was reduced to only four patients, two Grade 2 and two Grade 1.

Conclusions

No excessive, unwarranted toxicities were observed using concomitant low doses boost in IMRT. High rates of compliance to concurrent chemotherapy were achieved. Late xerostomia associated with this regime decreased 1 year after conclusion of treatment. The implementation of IMRT requires advances in imaging for better tumor delineation; otherwise the physician loses the advantage of dose modulation or faces a risk of geographical miss.
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Metadata
Title
IMRT: preliminary results in a series of advanced head-and-neck cancer patients
Authors
Antonio Vila Capel
Jorge Vilar Palop
Agustín Pedro Olivé
Alberto Sanchez-Reyes Fernandez
Jordi Vayreda Ribera
Joan Carles Julià Sanahuja
Joaquim Pérez de Olaguer Agustín
Nuria Artola Codina
Luis Miguel Moya Cascant
Esther Rubio Calatayud
Gemma Carrera Domenech
Publication date
01-03-2013
Publisher
Springer Milan
Published in
Clinical and Translational Oncology / Issue 3/2013
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-012-0911-2

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