Daniela Alterio1, Emma D'Ippolito2, Barbara Vischioni2, Piero Fossati1,2, Sara Gandini3, Maria Bonora2, Sara Ronchi2, Viviana Vitolo2, Edoardo Mastella2, Giuseppe Magro2, Pierfrancesco Franco4, Umberto Ricardi4, Marco Krengli5, Giovanni Ivaldi6, Annamaria Ferrari1, Giuseppi Fanetti1,7, Stefania Comi8, Marta Tagliabue9, Elena Verri10, Rosalinda Ricotti2, Delia Ciardo1, Barbara Alicja Jereczek-Fossa1,7, Francesca Valvo2, Roberto Orecchia11,12. 1. Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy. 2. Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy, Pavia, Italy. 3. Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy. 4. Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy. 5. Department of Translational Medicine, Novara, University of Piemonte Orientale, Vercelli, Italy. 6. Unit of Radiation Oncology, ICS Maugeri, IRCSS, Pavia, Italy. 7. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. 8. Unit of Medical Physics, European Institute of Oncology, Milan, Italy. 9. Department of Head and Neck Surgery and Otorhinolaryngology, IEO, European Institute of Oncology IRCCS, Milan, Italy. 10. Department of Medical Oncology, European Institute of Oncology, Milan, Italy. 11. Scientific Direction, European Institute of Oncology IRCCS, Milan, Italy. 12. Scientific Direction, National Center of Oncological Hadrontherapy, Pavia, Italy.
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.
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 LANPCpatients 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.
Authors: Kenneth C W Wong; Edwin P Hui; Kwok-Wai Lo; Wai Kei Jacky Lam; David Johnson; Lili Li; Qian Tao; Kwan Chee Allen Chan; Ka-Fai To; Ann D King; Brigette B Y Ma; Anthony T C Chan Journal: Nat Rev Clin Oncol Date: 2021-06-30 Impact factor: 66.675
Authors: Wai Tong Ng; Barton But; Charlene H L Wong; Cheuk-Wai Choi; Melvin L K Chua; Pierre Blanchard; Anne W M Lee Journal: Clin Transl Radiat Oncol Date: 2022-08-23