1. Mixed-beam approach in locally advanced nasopharyngeal carcinoma: IMRT followed by proton therapy boost versus IMRT-only. Evaluation of toxicity and efficacy
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Alterio, (Alterio, D, 1 ), Daniela), D'Ippolito, (D'Ippolito, E, 2 ), Emma), Vischioni, (Vischioni, B, 2 ), Barbara), Fossati, (Fossati, P, Piero)(, 1, Gandini, 2, (Gandini, S, 3 ), Sara), Bonora, (Bonora, M, 2 ), Maria), Ronchi, (Ronchi, S, 2 ), Sara), Vitolo, (Vitolo, V, 2 ), Viviana), Mastella, (Mastella, E, 2 ), Edoardo), Magro, (Magro, G, 2 ), Giuseppe), Franco, (Franco, P, 4 ), Pierfrancesco), Ricardi, (Ricardi, U, 4 ), Umberto), Krengli, Marco, (Krengli, M, 5 ), Marco), Ivaldi, (Ivaldi, G, 6 ), Giovanni), Ferrari, (Ferrari, A, 1 ), Annamaria), Fanetti, (Fanetti, G, Giuseppi)(, 1, Comi, 7, (Comi, S, 8 ), Stefania), Tagliabue, (Tagliabue, M, 9 ), Marta), Verri, (Verri, E, Elena)( 10, ), Ricotti, (Ricotti, R, 2 ), Rosalinda), Ciardo, (Ciardo, D, 1 ), Delia), Jereczek-Fossa, (Jereczek-Fossa, Ba, Barbara Alicja)(, 1, Valvo, 7, (Valvo, F, 2 ), Francesca), Orecchia, (Orecchia, R, Roberto)(, 11, and Less, 12
- Subjects
Male ,medicine.medical_treatment ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,Proton Therapy ,Neoadjuvant therapy ,Nasopharyngeal Carcinoma ,Radiotherapy Dosage ,Chemoradiotherapy ,Hematology ,General Medicine ,Middle Aged ,CHEMOTHERAPY ,CANCER ,Neoadjuvant Therapy ,Progression-Free Survival ,Oncology ,030220 oncology & carcinogenesis ,Disease Progression ,SURVIVAL ,Female ,Radiology ,Adult ,Mucositis ,medicine.medical_specialty ,Adolescent ,Nasopharyngeal neoplasm ,Xerostomia ,Young Adult ,03 medical and health sciences ,INTENSITY-MODULATED RADIOTHERAPY ,2-DIMENSIONAL RADIOTHERAPY ,RADIATION ,HEAD ,ONCOLOGY ,medicine ,Humans ,Dosimetry ,Radiology, Nuclear Medicine and imaging ,Radiation Injuries ,Proton therapy ,Aged ,Neoplasm Staging ,Retrospective Studies ,Cancer staging ,business.industry ,Dose-Response Relationship, Radiation ,Nasopharyngeal Neoplasms ,medicine.disease ,Radiation therapy ,Nasopharyngeal carcinoma ,Radiotherapy, Intensity-Modulated ,business ,Follow-Up Studies - Abstract
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.
- Published
- 2020
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