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IMRT with simultaneous integrated boost and concurrent chemotherapy for nasopharyngeal cancer: plan evaluation and treatment outcomeoutcome

 Jun Won Kim  ;  Jae Ho Cho  ;  Ki Chang Keum  ;  Joo Ho Kim  ;  Gwi Eon Kim  ;  Jong Young Lee  ;  Soo Kon Kim  ;  Chang Geol Lee 
 JAPANESE JOURNAL OF CLINICAL ONCOLOGY, Vol.42(12) : 1152-1160, 2012 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Antineoplastic Agents/administration & dosage ; Chemoradiotherapy*/adverse effects ; Cisplatin/administration & dosage ; Female ; Humans ; Japan ; Male ; Middle Aged ; Nasopharyngeal Neoplasms/therapy* ; Radiation Dosage ; Radiotherapy, Intensity-Modulated/adverse effects ; Radiotherapy, Intensity-Modulated/methods* ; Safety ; Survival Analysis ; Tissue Distribution
nasopharyngeal cancer ; IMRT ; simultaneous integrated boost ; concurrent chemotherapy
OBJECTIVE: This study evaluated the outcome of intensity-modulated radiation therapy with simultaneous integrated boost and concurrent chemotherapy for nasopharyngeal cancer. METHODS: We analyzed 53 consecutive nasopharyngeal cancer patients who received definitive treatment using intensity-modulated radiation therapy with simultaneous integrated boost and cisplatin-based concurrent chemotherapy. Forty-six patients were treated with concurrent chemoradiation and seven patients with induction chemotherapy plus concurrent chemoradiation. The gross tumor (PTV(70)) received 69.96 Gy (2.12 Gy/fraction), high-risk subclinical disease (PTV(60)) received 59.4 Gy (1.8 Gy/fraction) and low-risk subclinical disease (PTV(56)) received 56.1 Gy (1.7 Gy/fraction) in 33 fractions. Twenty-eight patients were treated with step-and-shoot intensity-modulated radiation therapy and 25 patients with helical tomotherapy. Dosimetric parameters were compared between the two modalities. RESULTS: The median treatment duration was 49 days (range: 41-65 days). The complete response rate was 92.5%. Three local, two regional, one locoregional and seven distant failures were observed. With the median follow-up of 41 months (range: 8-89 months), the 3- and 5-year local control, locoregional control, disease-free survival and overall survival rates were 91.8 and 91.8%; 87.6 and 87.6%; 77.5 and 70.5%; and 86.4 and 82.1%, respectively. Grade 3 mucositis, dermatitis, leucopenia and grade 4 leucopenia were observed in 10, 1, 2 and 1 patient, respectively. No grade 3 or higher xerostomia occurred. Helical tomotherapy significantly improved dosimetric parameters including the maximum dose, volume receiving >107% of the prescribed dose and uniformity index (D(5)/D(95)). CONCLUSIONS: Intensity-modulated radiation therapy with simultaneous integrated boost with concurrent chemotherapy is a safe and effective treatment modality for nasopharyngeal cancer. Helical tomotherapy has a dosimetric advantage over step-and-shoot intensity-modulated radiation therapy in a clinical setting.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Gwi Eon(김귀언)
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
Cho, Jae Ho(조재호) ORCID logo https://orcid.org/0000-0001-9966-5157
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