IMRT with the Use of Simultaneous Integrated Boost in Treatment of Head and Neck Cancer: Acute Toxicity Evaluation

Abstract

Acute toxicity has been evaluated in head and neck cancer patients treated with intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT). The basis of the treatment protocol is an irradiation in 30 fractions with a total dose: 66 Gy to the region of macroscopic tumor, 60 Gy to the region of high-risk subclinical disease and 54 Gy to the region of low-risk subclinical disease. Between December 2003 and September 2005, 38 patients with carcinoma of different locations in the head and neck region were irradiated. Five patients underwent concurrent chemotherapy (weekly cisplatin). Acute toxicity was evaluated according to Radiation Therapy Oncology Group toxicity scale for skin, mucous membrane, salivary glands, pharynx and esophagus and larynx. All 38 patients completed the therapy without urgency of interruption due to acute toxicity of radiotherapy. No patient experienced grade 4 toxicity. More severe toxicity was observed in patients with concurrent chemotherapy. The results confirm that the irradiation according to our SIB-IMRT protocol is a therapy with acceptable toxicity and there is a space for radiobiological enhancement of this regimen by concurrent chemotherapy, e.g. weekly cisplatin.

Evaluation of Spatially Fractionated Radiotherapy (GRID) and Definitive Chemoradiotherapy With Curative Intent for Locally Advanced Squamous Cell Carcinoma of the Head and Neck: Initial Response Rates and Toxicity

“…The chemotherapy used for each patient is shown in Table 1. The details of SIB-IMRT have been discussed previously (10,11). In this work, PTV, PTV-INT, and PTV-LOW prescribed radiation doses were 66, 60, and 54 Gy in 30 fractions, respectively.…”

A systematic review of dysgeusia induced by cancer therapies

“…A third study, evaluating 38 head and neck cancer patients treated with radiotherapy +/− chemotherapy, reported that all patients had some degree of dysgeusia although the grade of dysgeusia was never reported as severe [32].…”

Do selective radiation dose escalation and tumour hypoxia status impact the loco-regional tumour control after radio-chemotherapy of head & neck tumours? The ESCALOX protocol

“…In addition to better sparing of normal tissues, IMRT also allows escalating the radiation dose selectively to sub-volumes of the tumour. Simultaneously Integrated Boost technique (SIB-IMRT) is well described and evaluated especially regarding its acute and late toxicity [ 9 , 30 , 49 – 51 ]. This is true for salivary glands and for the mucosa [ 22 – 24 , 27 , 52 – 54 ].…”