A randomized prospective study comparing acute toxicity, compliance and objective response rate between simultaneous integrated boost and sequential intensity-modulated radiotherapy for locally advanced head and neck cancer

Abstract

Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IM-RT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer. Materials and Methods: Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm's patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy. Results: Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783). Conclusion: Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.

Geometrical Comparison and Quantitative Evaluation of 18F-FDG PET/CT- and DW-MRI-Based Target Delineation Before and During Radiotherapy for Esophageal Squamous Carcinoma

“…In this single-center prospective study, comparisons of the spatial overlap and functional markers derived from 18 F-FDG PET-CT and DW-MRI before and during RT based on the medium of CT imaging were evaluated. The results of the current study show that it is feasible to select boosting of high 18 F-FDG uptake zones within the GTV based on FDG PET-CT for definition of the volume in need of dose escalation ( 4 , 5 , 23 ). However, owing to exorbitant costs and physical burden to patients undergoing repeated PET procedures, MRI-guided Linear Accelerator (MRI-LINAC) with online MR-guided adaptive radiotherapy (MRgRT) in EC has been widely applied ( 24 ).…”

“…Hence, there is an urgent need to escalate the radiation dose to the area at highest risk of recurrence to improve locoregional control. Currently, there is a growing interest in the delivery of intensity-modulated radiotherapy (IMRT)-based late course boost or simultaneously integrated boost techniques ( 4 , 5 ), which could selectively deliver high radiation doses to radioresistant regions and a relatively low dose to subclinical tissues.…”

Impact of a mobile application (reminder app) on acute toxicity during radiotherapy of head-and-neck cancer – results of a randomized phase III trial (RAREST-02)

“…In the randomized prospective study of Grover et al . , patients receiving IMRT with a sequential boost had grade ≥ 2 dermatitis and mucositis rates of 59% and 88%, respectively, and corresponding grade ≥ 3 rates of 45% and 14%, respectively [ 16 ]. In another randomized study, patients receiving IMRT plus weekly cisplatin grade ≥ 2 dermatitis and mucositis rates were 72% and 100%, respectively, and corresponding grade ≥ 3 rates were 12% and 60%, respectively [ 17 ].…”

Detailed analysis of failure patterns using deformable image registration in hypopharyngeal cancer patients treated with sequential boost intensity‐modulated radiotherapy

“…D max , maximum dose; D mean , mean dose; D min , minimum dose; V 66.5 Gy , the volume receiving more than 66.5 Gy. Previous studies [25][26][27][28][29] have reported that SQB-IMRT is equivalent to SIB-IMRT in terms of treatment outcomes for patients with HNC. A few prospective randomized trials [27][28][29] have been conducted, and comparable treatment outcomes were reported.…”

“…Previous studies [25][26][27][28][29] have reported that SQB-IMRT is equivalent to SIB-IMRT in terms of treatment outcomes for patients with HNC. A few prospective randomized trials [27][28][29] have been conducted, and comparable treatment outcomes were reported. We believe that the findings in our study are consistent with these results and provide evidence to support that the clinical outcomes of SQB and SIB-IMRT are comparable, even in patients with hypopharyngeal cancer.…”