Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the Memorial Sloan-Kettering experience Journal Article

Authors: Wolden, S. L.; Chen, W. C.; Pfister, D. G.; Kraus, D. H.; Berry, S. L.; Zelefsky, M. J.
Article Title: Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the Memorial Sloan-Kettering experience
Abstract: Purpose: We previously demonstrated that intensity-modulated radiation therapy (IMRT) significantly improves radiation dose distribution over three-dimensional planning for nasopharynx cancer and reported positive early clinical results. We now evaluate whether IMRT has resulted in improved outcomes for a larger cohort of patients with longer follow-up. Methods and Materials: Since 1998, all 74 patients with newly diagnosed, nonmetastatic nasopharynx cancer were treated with IMRT using accelerated fractionation to 70 Gy; 59 received a hyperfractionated concomitant boost, and more recently 15 received once-daily treatment with dose painting. With the exception of Stage I disease (n = 5) and patient preference (n = 1), 69 patients received concurrent and adjuvant platinum-based chemotherapy similar to that in the Intergroup 0099 trial. Results: Patient characteristics: median age 45; 32% Asian; 72% male; 65% World Health Organization III; 6% Stage I, 16% Stage II, 30% Stage III, 47% Stage IV. Median follow-up is 35 months. The 3-year actuarial rate of local control is 91%, and regional control is 93%; freedom from distant metastases, progression-free survival, and overall survival at 3 years are 78%, 67%, and 83%, respectively. There was 100% local control for Stage T1/T2 disease, compared to 83% for T3/T4 disease (p = 0.01). Six patients failed at the primary site, with median time to local tumor progression 16 months; 5 were exclusively within the 70 Gy volume, and 1 was both within and outside the target volume. There is a trend for improved local control with IMRT when compared to local control of 79% for 35 patients treated before 1998 with three-dimensional planning and chemotherapy (p = 0.11). Six months posttherapy, 21%, 13%, 15%, and 0% of patients with follow-up audiograms (n = 24 patients) had Grade 1, 2, 3, and 4 sensorineural hearing loss, respectively. For patients with >1 year follow-up (n = 59), rates of long-term xerostomia were as follows: 26% none, 42% Grade 1, 32% Grade 2, and zero Grade 3. Conclusions: The pattern of primary site failure within the target volume suggests locally advanced T stage disease may require a higher biologic dose to gross tumor. Rates of severe (Grade 3-4) ototoxicity and xerostomia are low with IMRT as a result of normal-tissue protection. Distant metastases are now the dominant form of failure, emphasizing the need for improved systemic therapy. © 2006 Elsevier Inc.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; controlled study; human tissue; aged; middle aged; retrospective studies; major clinical study; intensity modulated radiation therapy; cisplatin; fluorouracil; dose response; systemic therapy; treatment planning; conference paper; cancer radiotherapy; comparative study; radiation dose; chemotherapy, adjuvant; chemotherapy; cancer staging; outcome assessment; follow up; radiotherapy dosage; radiotherapy; cohort analysis; oncology; radiotherapy, intensity-modulated; dosimetry; diagnosis; xerostomia; platinum; world health organization; tumor growth; fractionation; disease control; nasopharynx cancer; nasopharyngeal neoplasms; intensity-modulated radiation therapy; hearing loss; ototoxicity; perception deafness; nasopharyngeal cancer; intensity-modulated radiation therapy (imrt)
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 64
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2006-01-01
Start Page: 57
End Page: 62
Language: English
DOI: 10.1016/j.ijrobp.2005.03.057
PUBMED: 15936155
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 135" - "Export Date: 4 June 2012" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Michael J Zelefsky
    624 Zelefsky
  2. Dennis Kraus
    259 Kraus
  3. Suzanne L Wolden
    424 Wolden
  4. Sean L Berry
    31 Berry
  5. David G Pfister
    251 Pfister
  6. William C Chen
    5 Chen