Objective: To compare radiation-induced toxicity and dosimetry parameters in patients with locally advanced nasopharyngeal cancer (LANPC) treated with a mixed-beam (MB) approach (IMRT followed by proton therapy boost) with an historic cohort of patients treated with a full course of IMRT-only. Material and methods: Twenty-seven patients with LANPC treated with the MB approach were compared to a similar cohort of 17 patients treated with IMRT-only. The MB approach consisted in a first phase of IMRT up to 54–60 Gy followed by a second phase delivered with a proton therapy boost up to 70–74 Gy (RBE). The total dose for patients treated with IMRT-only was 69.96 Gy. Induction chemotherapy was administrated to 59 and 88% and concurrent chemoradiotherapy to 88 and 100% of the MB and IMRT-only patients, respectively. The worst toxicity occurring during the entire course of treatment (acute toxicity) and early-late toxicity were registered according to the Common Terminology Criteria Adverse Events V4.03. Results: The two cohorts were comparable. Patients treated with MB received a significantly higher median total dose to target volumes (p =.02). Acute grade 3 mucositis was found in 11 and 76% (p =.0002) of patients treated with MB and IMRT-only approach, respectively, while grade 2 xerostomia was found in 7 and 35% (p =.02) of patients treated with MB and IMRT-only, respectively. There was no statistical difference in late toxicity. Local progression-free survival (PFS) and progression-free survival curves were similar between the two cohorts of patients (p =.17 and p =.40, respectively). Local control rate was 96% and 81% for patients treated with MB approach and IMRT-only, respectively. Conclusions: Sequential MB approach for LANPC patients provides a significantly lower acute toxicity profile compared to full course of IMRT. There were no differences in early-late morbidities and disease-related outcomes (censored at two-years) but a longer follow-up is required to achieve conclusive results.

Mixed-beam approach in locally advanced nasopharyngeal carcinoma: IMRT followed by proton therapy boost versus IMRT-only. Evaluation of toxicity and efficacy / D. Alterio, E. D'Ippolito, B. Vischioni, P. Fossati, S. Gandini, M. Bonora, S. Ronchi, V. Vitolo, E. Mastella, G. Magro, P. Franco, U. Ricardi, M. Krengli, G. Ivaldi, A. Ferrari, G. Fanetti, S. Comi, M. Tagliabue, E. Verri, R. Ricotti, D. Ciardo, B.A. Jereczek-Fossa, F. Valvo, R. Orecchia. - In: ACTA ONCOLOGICA. - ISSN 0284-186X. - 59:5(2020), pp. 541-548. [10.1080/0284186X.2020.1730001]

Mixed-beam approach in locally advanced nasopharyngeal carcinoma: IMRT followed by proton therapy boost versus IMRT-only. Evaluation of toxicity and efficacy

B.A. Jereczek-Fossa;
2020

Abstract

Objective: To compare radiation-induced toxicity and dosimetry parameters in patients with locally advanced nasopharyngeal cancer (LANPC) treated with a mixed-beam (MB) approach (IMRT followed by proton therapy boost) with an historic cohort of patients treated with a full course of IMRT-only. Material and methods: Twenty-seven patients with LANPC treated with the MB approach were compared to a similar cohort of 17 patients treated with IMRT-only. The MB approach consisted in a first phase of IMRT up to 54–60 Gy followed by a second phase delivered with a proton therapy boost up to 70–74 Gy (RBE). The total dose for patients treated with IMRT-only was 69.96 Gy. Induction chemotherapy was administrated to 59 and 88% and concurrent chemoradiotherapy to 88 and 100% of the MB and IMRT-only patients, respectively. The worst toxicity occurring during the entire course of treatment (acute toxicity) and early-late toxicity were registered according to the Common Terminology Criteria Adverse Events V4.03. Results: The two cohorts were comparable. Patients treated with MB received a significantly higher median total dose to target volumes (p =.02). Acute grade 3 mucositis was found in 11 and 76% (p =.0002) of patients treated with MB and IMRT-only approach, respectively, while grade 2 xerostomia was found in 7 and 35% (p =.02) of patients treated with MB and IMRT-only, respectively. There was no statistical difference in late toxicity. Local progression-free survival (PFS) and progression-free survival curves were similar between the two cohorts of patients (p =.17 and p =.40, respectively). Local control rate was 96% and 81% for patients treated with MB approach and IMRT-only, respectively. Conclusions: Sequential MB approach for LANPC patients provides a significantly lower acute toxicity profile compared to full course of IMRT. There were no differences in early-late morbidities and disease-related outcomes (censored at two-years) but a longer follow-up is required to achieve conclusive results.
Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Chemoradiotherapy; Disease Progression; Dose-Response Relationship, Radiation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mucositis; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Neoadjuvant Therapy; Neoplasm Staging; Progression-Free Survival; Proton Therapy; Radiation Injuries; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Retrospective Studies; Severity of Illness Index; Xerostomia; Young Adult
Settore MED/36 - Diagnostica per Immagini e Radioterapia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/940280
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