Artikel
Combined modality approaches in the treatment of head-and-neck cancer patients: a retrospective single institution analysis
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Autoren
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A. Guido
- Radiotherapy Department, S.Orsola-Malpighi Hospital Bologna University, Bologna, Italy
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A. Cecconi
- Radiotherapy Department, S.Orsola-Malpighi Hospital Bologna University, Bologna, Italy
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F. Bunkheila
- Radiotherapy Department, S.Orsola-Malpighi Hospital Bologna University, Bologna, Italy
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E. Barbieri
- Radiotherapy Department, S.Orsola-Malpighi Hospital Bologna University, Bologna, Italy
| Veröffentlicht: | 24. September 2009 |
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Gliederung
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Background: To review our experience using intensity-modulated radiation therapy (IMRT) plus chemotherapy for the treatment of head-and-neck cancer.
Materials and methods: Between April 2006 and June 2009, 83 patients with head-and-neck squamous cell carcinoma were treated with IMRT using an inverse plan and simultaneously integrated boost for curative intent (46 pt) or postoperative adjuvant setting (37 pt). There were 56 males and 27 females, with a mean age of 60.4 years (range, 37-82 years). The localization of tumor was: 11 nasopharynx , and 72 oropharynx .All patients but 20 ( 3/46 and 17/37 IMRT alone) receveid concurrent chemotherapy and 10 of these received the addition of anti-EGFR monoclonal antibody ( MoAb) Cetuximab. Three clinical target volumes (CTV1, CTV2 and CTV3 for radical treatment) were defined as following. For nasopharynx cancer the prescribed doses were 70 Gy to the region of macroscopic tumor (CTV1), 59.4 Gy to the region of high-risk subclinical disease (CTV2) and 50.4 Gy to the region of low-risk subclinical disease. For oropharynx cancer the prescribed doses to CTV1, CTV2 and CTV3 were 66 Gy, 60Gy and 54 Gy, respectively.
For postoperative IMRT, the prescribed dose to CTV1 and CTV2 were : CTV1 (concomitant boost): 59.4 Gy (to the region of disease and positives nodes), CTV2 : 50 Gy (to the region of low-risk subclinical disease ).
Acute and late toxicity were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria.
Results: All patients except 8 were still alive with no disease after a mean period of follow-up 21.5 months (range 2–28 months): five had nodal or primary site recurrence and 3 died: one for nodal recurrence and two for primary site relapse after a mean period of 9 months from the end of treatment.
Acute reactions were mild to moderate. The worst acute mucositis experienced was Grade 1 in 32 pts, Grade 2 in 51pts and no patient had grade 3 toxicity.Xerostomia decreased with increasing time interval from the end of radiotherapy.The acute skin reaction for the pts treated with-EGFR monoclonal antibody ( MoAb) Cetuximab was G2 for 2 pts and Gr.3 for 8 pts.
Conclusion: This retrospective analysis confirmed the effectiveness of IMRT in association to concurrent chemotherapy,it reveals a very good outcome in local-regional control and disease free survival and an acceptable toxicity profile.Nowadays a longer follow-up is necessary to evaluate late toxicity and others effects.
