Feasibility Study of Moderately Accelerated Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin After Induction Chemotherapy in Locally Advanced Head-and Neck Cancer

Journal Article · Tue Mar 15 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.12.020· OSTI ID:21491656

Morganti, Alessio G ^[1]; Mignogna, Samantha ^[2]; Deodato, Francesco; Massaccesi, Mariangela ^[1]; Cilla, Savino ^[3]; Calista, Franco ^[2]; Serafini, Giovanni ^[4]; Digesu, Cinzia ^[1]; Macchia, Gabriella ^[1]; Picardi, Vincenzo; Caravatta, Luciana ^[1]; Di Lullo, Liberato ^[5]; Giglio, Gianfranco ^[6]; Sallustio, Giuseppina ^[7]; Piermattei, Angelo ^[3]

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1. Department of Radiotherapy, 'John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Campobasso (Italy)
2. Department of Palliative Therapies, 'John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Campobasso (Italy)
3. Department of Medical Physics, 'John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Campobasso (Italy)
4. Department of Head and Neck Surgery, General Hospital, Termoli (Italy)
5. Department of Oncology, General Hospital, Isernia (Italy)
6. Department of Oncology, General Hospital, Campobasso (Italy)
7. Department of Radiology, 'John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Campobasso (Italy)

Purpose: To evaluate the feasibility and efficacy of moderately accelerated intensity-modulated radiation therapy (IMRT) along with weekly cisplatin, after induction chemotherapy, in patients with locally advanced unresectable head and neck cancer (HNC). Methods and Materials: Patients with Stage III or IV locally advanced HNC, without progressive disease after three courses of induction chemotherapy, received concurrent chemo-IMRT (weekly cisplatin 30 mg/m{sup 2} plus simultaneous integrated boost IMRT). A total of 67.5 Gy in 30 fractions were delivered to primary tumor and involved nodes, 60 Gy in 30 fractions to high-risk nodal areas, and 55.5 Gy in 30 fractions to low-risk nodal areas. Results: In all, 36 patients (median age, 56 years) with International Union Against Cancer (UICC) Stage III (n = 5) and IV (n = 31) were included. Of the 36 patients, 17 had received CF (cisplatin and 5-fluorouracil (CF) and 19 had received docetaxel cisplatin and 5-fluorouracil (DCF). During concurrent chemoradiation, 11 of 36 patients (30.5%) experienced Grade III mucositis (CF, 47%; DCF, 15%; p < 0.04). Grade III pharyngeal-esophageal toxicity was observed in 5 of 19 patients (26.3%; CF, 0.0%; DCF, 26.3%; p = 0.02). Two patients died of complications (5.5%). After chemoradiation, the complete response rate was 63.8%. Two-year local control was 88.7%. Two-year progression free survival and overall survival were 74.5% and 60.9%, respectively. Conclusions: In our experience, a moderately accelerated chemo-IMRT was feasible after induction chemotherapy. However, a noteworthy early death rate of 5.5% was observed. Intensive supportive care strategies should be defined to better manage radiation-induced toxic effects. Longer follow-up is required to determine the incidence of late radiation toxicities and tumor control rates.

• OSTI ID: 21491656
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 79, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2009.12.020; PII: S0360-3016(09)03685-2; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANTINEOPLASTIC DRUGS
CHEMOTHERAPY
FEASIBILITY STUDIES
HEAD
NECK
NEOPLASMS
RADIOTHERAPY
TOXICITY
URACILS
AZINES
BODY
DISEASES
DRUGS
HETEROCYCLIC COMPOUNDS
HYDROXY COMPOUNDS
MEDICINE
NUCLEAR MEDICINE
ORGANIC COMPOUNDS
ORGANIC NITROGEN COMPOUNDS
PYRIMIDINES
RADIOLOGY
THERAPY