Intensity‐modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma

Abstract

BACKGROUND.Treatment outcomes for stage III and IV oropharyngeal carcinoma treated with intensity‐modulated radiotherapy (IMRT) and concurrent chemotherapy without prior surgical resection were reviewed.METHODS.Between April 2000 and September 2004, 71 patients underwent IMRT concurrent with chemotherapy without prior surgical resection for stage III and IV oropharyngeal carcinoma. Chemotherapy was platinum based. The gross tumor volume (GTV) received 70 Gy in 2.12 Gy per fraction. The high‐risk clinical tumor volume (CTV) received 59.4 Gy in 1.80 Gy per fraction, and the low‐risk CTV received 54 Gy in 1.64 Gy per fraction.RESULTS.With a median follow‐up of 33 months, the 3‐year local, regional, and locoregional progression‐free probabilities were 94%, 94%, and 90%, respectively. The 3‐year overall survival estimate was 83%. Locoregional failures occurred in the GTV in 7 patients. Acute grade 3 or 4 toxicity developed in 35 patients. A feeding gastrostomy was placed in 25 patients. Late xerostomia was grade 0 in 16 patients, grade 1 in 31 patients, and grade 2 in 24 patients at last follow‐up. No patients experienced grade 3 or 4 late toxicity, except for 1 who developed osteoradionecrosis of the mandible.CONCLUSIONS.Excellent local and regional control was achieved with IMRT and concurrent chemotherapy without prior surgical resection in the treatment of stage III and IV oropharyngeal carcinoma. Significant sparing of the parotid glands and other critical normal tissues was possible using IMRT with moderate acute toxicities and minimal severe late effects. Cancer 2008. © 2008 American Cancer Society.

Definitive radiotherapy for head and neck squamous cell carcinoma: update and perspectives on the basis of EBM

“…Patients with OPC-related HPV infection have a favorable prognosis (37)(38)(39), and radiotherapy plays an important role among the treatment modalities available for these patients. The adaptation of IMRT could reduce the rate of late toxicity especially xerostomia; thus, it is considered a standard method in definitive RT for OPC (40,41). Several RCT have been conducted to demonstrate the advantages of IMRT for HNSCC patients including OPC (11,13).…”

Intensity Modulated Radiation Therapy (IMRT) in the Treatment of Squamous Carcinoma of the Oropharynx: An Overview

“…on its pathophysiology have promoted more frequent use of new treatment modalities including the use of IMRT. We identified nine studies [3,22,[38][39][40][41][42][43][44][45] which had included patients with oropharyngeal carcinoma treated with IMRT and which had reported the incidence of osteoradionecrosis. Table 4 shows a summary of the results.…”

“…It is well recognised that dental examination before treatment together with close multi-disciplinary team working with the local restorative dentist and dental hygienist will significantly reduce the risk of ORN [31]. The studies [3,22,[39][40][41][42][43][44][45] that have evaluated the reduction of ORN with IMRT in oropharyngeal cancer treatment have reported an extremely low rate of ORN with IMRT. However, the RTOG -0022 [35] study has reported a 6% ORN rate.…”

“…The reasons cited include lack of standardised dental evaluation and the use of (relatively) hypofractionated regimes (2.2 Gy per fraction). The argument that 2.2 Gy per fraction may be the contributor to such an increase in the ORN rate may be less robust given that other studies [3,22,43] have used more than 2 Gy per fraction and have reported less ORN with IMRT. In summary, there are multiple reports from single centres flow rates of ORN with IMRT.…”

Dosimetric and radiobiological comparison of helical tomotherapy, forward-planned intensity-modulated radiotherapy and two-phase conformal plans for radical radiotherapy treatment of head and neck squamous cell carcinomas

“…The benefits of linear accelerator-based intensity-modulated radiotherapy (IMRT) in improving PTV conformity [2], and normal tissue complication probability (NTCP) by sparing OAR have been well documented. Several publications have addressed the benefits of IMRT in reducing xerostomia after radiotherapy [3][4][5][6][7][8][9][10][11][12][13][14].…”