Between 2002 and 2008, 208 patients with HNC were treated with IMRT in 8 centres. There were 38 nasopharynx, 117 oropharynx, 25 pharyngo-larynx, 24 oral cavity and 4 unknown primary (28.5%stage I-II and 71%Stage III-IV). Ninety-three patients (46%) had postoperative IMRT and 78 patients (37.5%) received concurrent chemotherapy. The doses were 70 Gy to the gross tumour, 66 Gy to the high-risk postoperative sites and 50 Gy to the subclinical disease. Toxicities were graded according to the RTOG-EORTC scales.
The median follow-up was 25.3 months (range: 0.4-72 months). There were 29 local-regional failures: 24 were in-field, three were marginal and one was out-field. The two-year loco-regional control and overall survival were 86%and 86.7%, respectively. At 18 months, grade 猢? xerostomia was 16.1%. A mean dose to the spared parotid below 28 Gy led to significantly less grade 猢? xerostomia (8.5%vs 24%) with a relative risk of 1.2 [95%CI: 1.02-1.41, p = 0.03]. Grade 猢? xerostomia increased by approximately 3%per Gy of mean parotid dose up to 28, Gy then 7%per Gy above 33 Gy.
IMRT for HN cancer seems to reduce late toxicities without jeopardising local control and overall survival.