Hypofractionated dose-painting intensity modulated radiation therapy with chemotherapy for nasopharyngeal carcinoma: A prospective trial Journal Article


Authors: Bakst, R. L.; Lee, N.; Pfister, D. G.; Zelefsky, M. J.; Hunt, M. A.; Kraus, D. H.; Wolden, S. L.
Article Title: Hypofractionated dose-painting intensity modulated radiation therapy with chemotherapy for nasopharyngeal carcinoma: A prospective trial
Abstract: Purpose: To evaluate the feasibility of dose-painting intensity-modulated radiation therapy (DP-IMRT) with a hypofractionated regimen to treat nasopharyngeal carcinoma (NPC) with concomitant toxicity reduction. Methods and Materials: From October 2002 through April 2007, 25 newly diagnosed NPC patients were enrolled in a prospective trial. DP-IMRT was prescribed to deliver 70.2 Gy using 2.34-Gy fractions to the gross tumor volume for the primary and nodal sites while simultaneously delivering 54 Gy in 1.8-Gy fractions to regions at risk of microscopic disease. Patients received concurrent and adjuvant platin-based chemotherapy similar to the Intergroup 0099 trial. Results: Patient and disease characteristics are as follows: median age, 46; 44% Asian; 68% male; 76% World Health Organization III; 20% T1, 52% T2, 16% T3, 12% T4; 20% N0, 36% N1, 36% N2, 8% N3. With median follow-up of 33 months, 3-year local control was 91%, regional control was 91%, freedom from distant metastases was 91%, and overall survival was 89%. The average mean dose to each cochlea was 43 Gy. With median audiogram follow-up of 14 months, only one patient had clinically significant (Grade 3) hearing loss. Twelve percent of patients developed temporal lobe necrosis; one patient required surgical resection. Conclusions: Preliminary findings using a hypofractionated DP-IMRT regimen demonstrated that local control, freedom from distant metastases, and overall survival compared favorably with other series of IMRT and chemotherapy. The highly conformal boost to the tumor bed resulted low rates of severe ototoxicity (Grade 3-4). However, the incidence of in-field brain radiation necrosis indicates that 2.34 Gy per fraction is not safe in this setting. © 2011 Elsevier Inc.
Keywords: adult; cancer survival; overall survival; clinical trial; intensity modulated radiation therapy; cisplatin; fluorouracil; cancer combination chemotherapy; cancer radiotherapy; radiation dose; chemotherapy; follow up; prospective study; carboplatin; multiple cycle treatment; radiotherapy; continuous infusion; pathology; distant metastasis; feasibility study; temporal lobe; physical therapy; tumors; nasopharynx carcinoma; world health organization; surgical resection; local control; nasopharyngeal carcinoma; brain necrosis; intensity-modulated radiation therapy; diseases; hearing loss; radiation necrosis; ototoxicity; hypofractionated; gross tumor volume; mean dose; audition; tumor bed; in-field; dose-painting; nasopharyngeal cancer; low rates; temporal lobes; toxicity reduction; health risks; hypofractionated dose painting intensity modulated radiation therapy
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 80
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2011-05-01
Start Page: 148
End Page: 153
Language: English
DOI: 10.1016/j.ijrobp.2010.01.026
PROVIDER: scopus
PMCID: PMC2952060
PUBMED: 20605352
DOI/URL:
Notes: --- - "Export Date: 23 June 2011" - "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. Nancy Y. Lee
    550 Lee
  5. David G Pfister
    251 Pfister
  6. Richard L Bakst
    15 Bakst
  7. Margie A Hunt
    229 Hunt