TY - JOUR
T1 - Mixed-beam approach in locally advanced nasopharyngeal carcinoma
T2 - IMRT followed by proton therapy boost versus IMRT-only. Evaluation of toxicity and efficacy
AU - Alterio, Daniela
AU - D'Ippolito, Emma
AU - Vischioni, Barbara
AU - Fossati, Piero
AU - Gandini, Sara
AU - Bonora, Maria
AU - Ronchi, Sara
AU - Vitolo, Viviana
AU - Mastella, Edoardo
AU - Magro, Giuseppe
AU - Franco, Pierfrancesco
AU - Ricardi, Umberto
AU - Krengli, Marco
AU - Ivaldi, Giovanni
AU - Ferrari, Annamaria
AU - Fanetti, Giuseppi
AU - Comi, Stefania
AU - Tagliabue, Marta
AU - Verri, Elena
AU - Ricotti, Rosalinda
AU - Ciardo, Delia
AU - Jereczek-Fossa, Barbara Alicja
AU - Valvo, Francesca
AU - Orecchia, Roberto
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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.
KW - Adolescent
KW - Adult
KW - Aged
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Chemoradiotherapy/methods
KW - Disease Progression
KW - Dose-Response Relationship, Radiation
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Mucositis/diagnosis
KW - Nasopharyngeal Carcinoma/mortality
KW - Nasopharyngeal Neoplasms/mortality
KW - Neoadjuvant Therapy/methods
KW - Neoplasm Staging
KW - Progression-Free Survival
KW - Proton Therapy/adverse effects
KW - Radiation Injuries/diagnosis
KW - Radiotherapy Dosage
KW - Radiotherapy, Intensity-Modulated/adverse effects
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Xerostomia/diagnosis
KW - Young Adult
U2 - 10.1080/0284186X.2020.1730001
DO - 10.1080/0284186X.2020.1730001
M3 - Article
C2 - 32090645
VL - 59
SP - 541
EP - 548
JO - Acta Oncologica
JF - Acta Oncologica
SN - 0001-6381
IS - 5
ER -