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
N1 - Publisher Copyright:
© 2020, © 2020 Acta Oncologica Foundation.
PY - 2020/5/3
Y1 - 2020/5/3
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.
UR - https://www.scopus.com/pages/publications/85082561218
U2 - 10.1080/0284186X.2020.1730001
DO - 10.1080/0284186X.2020.1730001
M3 - Article
SN - 0284-186X
VL - 59
SP - 541
EP - 548
JO - Acta Oncologica
JF - Acta Oncologica
IS - 5
ER -
