A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma Journal Article


Authors: Lee, N. Y.; De Arruda, F. F.; Puri, D. R.; Wolden, S. L.; Narayana, A.; Mechalakos, J.; Venkatraman, E. S.; Kraus, D.; Shaha, A.; Shah, J. P.; Pfister, D. G.; Zelefsky, M. J.
Article Title: A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma
Abstract: Purpose: The aim of this study was to compare toxicity/efficacy of conventional radiotherapy using delayed accelerated concomitant boost radiotherapy (CBRT) vs. intensity-modulated radiotherapy (IMRT) in the setting of concurrent chemotherapy (CT) for locally advanced oropharyngeal carcinoma. Methods and Materials: Between September 1998 and June 2004, a total of 293 consecutive patients were treated at our institution for cancer of the oropharynx. Of these, 112 had Stage III/IV disease and squamous cell histology. In all, 41 were treated with IMRT/CT and 71 were treated with CBRT/CT, both to a median dose of 70 Gy. Most common CT was a planned two cycles given every 3 to 4 weeks of cisplatin, 100 mg/m2 i.v., but an additional cycle was given to IMRT patients when possible. Both groups were well-matched for all prognostic factors. Results: Median follow-up was 46 months (range, 3-93 months) for the CBRT patients and 31 months (range, 20-64 months) for the IMRT group. Three-year actuarial local-progression-free, regional-progression-free, locoregional progression-free, distant-metastases-free, disease-free, and overall survival rates were 85% vs. 95% (p = 0.17), 95% vs. 94% (p = 0.90), 82% vs. 92% (p = 0.18), 85% vs. 86% (p = 0.78), 76% vs. 82% (p = 0.57), and 81% vs. 91% (p = 0.10) for CBRT and IMRT patients, respectively. Three patients died of treatment-related toxicity in the CBRT group vs. none undergoing IMRT. At 2 years, 4% IMRT patients vs. 21% CBRT patients were dependent on percutaneous endoscopic gastrostomy (p = 0.02). Among those who had ≥20 months follow-up, there was a significant difference in Grade ≥2 xerostomia as defined by the criteria of the Radiation Therapy and Oncology Group, 67% vs. 12% (p = 0.02), in the CBRT vs. IMRT arm. Conclusion: In the setting of CT for locally advanced oropharyngeal carcinoma, IMRT results in lower toxicity and similar treatment outcomes when compared with CBRT. © 2006 Elsevier Inc. All rights reserved.
Keywords: adult; cancer survival; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; survival rate; human cell; major clinical study; overall survival; cancer localization; intensity modulated radiation therapy; percutaneous endoscopic gastrostomy; cisplatin; advanced cancer; multimodality cancer therapy; treatment duration; antineoplastic agents; cancer radiotherapy; disease free survival; radiation dose; combined modality therapy; chemotherapy; follow up; metastasis; radiotherapy; prevalence; risk factors; oncology; histology; risk assessment; head and neck cancer; imrt; computerized tomography; xerostomia; disease free interval; radiotherapy, conformal; drug therapy; patient treatment; new york; time series analysis; endoscopy; oropharynx carcinoma; oropharyngeal neoplasms; head-and-neck cancer; oropharyngeal carcinoma; squamous cell; intensity-modulated; concomitant boost
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 66
Issue: 4
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2006-11-15
Start Page: 966
End Page: 974
Language: English
DOI: 10.1016/j.ijrobp.2006.06.040
PUBMED: 17145527
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 60" - "Export Date: 4 June 2012" - "CODEN: IOBPD" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Venkatraman Ennapadam Seshan
    288 Seshan
  2. Dev Raj Puri
    14 Puri
  3. Michael J Zelefsky
    624 Zelefsky
  4. Dennis Kraus
    259 Kraus
  5. Ashok R Shaha
    542 Shaha
  6. Suzanne L Wolden
    424 Wolden
  7. Nancy Y. Lee
    550 Lee
  8. David G Pfister
    251 Pfister
  9. Jatin P Shah
    544 Shah