Concurrent Chemoradiotherapy in Locally Advanced Head and Neck Cancer Using IMRT with SIB; NEMROCK Experience
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- Category: Vol. 85, June 2017
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Concurrent Chemoradiotherapy in Locally Advanced Head and Neck Cancer Using IMRT with SIB; NEMROCK Experience, HISHAM ATEF, HUSSAM ZAWAM and AHMED SELIM
Abstract
Background: Concurrent Chemo-Radiotherapy (CCRT) is the primary treatment modality for Locally Advanced Head and Neck Squamous Cell Carcinoma (LAHNSCC). Accelerated fractionation by Simultaneous Integrated Boost (SIB) has been shown to improve Local Control (LC). Adding chemo-therapy to AF is more efficacious than RT alone.
Objective: The technique of IMRT with SIB and concurrent chemotherapy is not broadly implicated in our region. This study aims at evaluation of the response and compliance of this approach in our patients.
Methods: Forty patients were included and 50% received induction chemotherapy. Weekly cisplatinum (40mg/m2) was administered during the radiation course. RT was administered using Intensity Modulated RT (IMRT) by step and shoot with SIB. The prescribed dose to the PTVgross disease was 69.96 Gy in 2.12-Gy fractions, the dose to the PTVsubclinical disease was 59.4 Gy in 1.8-Gy fractions, and the dose to the PTVlow-risk subclinical disease was 54.12 Gy in 1.64-Gy fractions.
Results: With median follow-up of 18 months, LC was achieved in 33 patients (82.5% of cases) and distant control rate was 90% (36 patients). More than 5 interrupted radiation sessions and GTV volume >50 cc significantly affected LC (p=0.02 and 0.001 respectively). Thirty two patients (80%) experienced grade 3 or 4 toxicities. Induction chemotherapy and PTV-70 volume >150 cc significantly affected the degree of toxicities (p=0.018 and 0.0001 respectively).
The 2 years Disease Free Survival (DFS) is 77%. ECOG PS, large GTV volume (>50 cc) and RT interruption (>5 sessions) had negative impact on DFS (p=0.041, 0.002 and 0.001 respectively). The 2 years Overall Survival (OS) is 87%. Radiation interruption (>5 sessions) was the only factor which had significant detrimental effect on OS (p=0.001).
Conclusion: Induction chemotherapy seems to have a negative impact on patient's compliance to CCRT. Bulky tumors and prolonged radiation interruptions were associated with significantly lower LRC, DFS and OS.