Elective Lymph Node Irradiation With Intensity-Modulated Radiotherapy: Is Conventional Dose Fractionation Necessary?

详细信息    查看全文

• 作者：Meena Bedi ; M.D. ; Selim Firat ; M.D. ; Vladimir A. Semenenko ; Ph.D. ; Christopher Schultz ; M.D. ; Patrick Tripp ; M.D. ; Roger Byhardt ; M.D. ; Dian Wang ; M.D. ; Ph.D. ; ^{dwang@mcw.edu}
• 关键词：Head and neck cancer ; Hypofractionation ; IMRT ; Radiotherapy
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 出版时间：1 May, 2012
• 年：2012
• 卷：83
• 期：1
• 页码：e87-e92
• 全文大小：500 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Purpose

Intensity-modulated radiation therapy (IMRT) is the standard of care for head-and-neck cancer (HNC). We treated patients with HNC by delivering either a moderate hypofractionation (MHF) schedule (66 Gy at 2.2 Gy per fraction to the gross tumor [primary and nodal]) with standard dose fractionation (54-60 Gy at 1.8-2.0 Gy per fraction) to the elective neck lymphatics or a conventional dose and fractionation (CDF) schedule (70 Gy at 2.0 Gy per fraction) to the gross tumor (primary and nodal) with reduced dose to the elective neck lymphatics. We analyzed these two cohorts for treatment outcomes.

Methods and Materials

Between November 2001 and February 2009, 89 patients with primary carcinomas of the oral cavity, larynx, oropharynx, hypopharynx, and nasopharynx received definitive IMRT with or without concurrent chemotherapy. Twenty patients were treated using the MHF schedule, while 69 patients were treated with the CDF schedule. Patient characteristics and dosimetry plans were reviewed. Patterns of failure including local recurrence (LR), regional recurrence (RR), distant metastasis (DM), disease-free survival (DFS), overall survival (OS), and toxicities, including rate of feeding tube placement and percentage of weight loss, were reviewed and analyzed.

Results

Median follow-up was 31.2 months. Thirty-five percent of patients in the MHF cohort and 77 % of patients in the CDF cohort received chemotherapy. No RR was observed in either cohort. OS, DFS, LR, and DM rates for the entire group at 2 years were 89.3 % , 81.4 % , 7.1 % , and 9.4 % , respectively. Subgroup analysis showed no significant differences in OS (p = 0.595), DFS (p = 0.863), LR (p = 0.833), or DM (p = 0.917) between these two cohorts. Similarly, no significant differences were observed in rates of feeding tube placement and percentages of weight loss.

Conclusions

Similar treatment outcomes were observed for MHF and CDF cohorts. A dose of 50 Gy at 1.43 Gy per fraction may be sufficient to electively treat low-risk neck lymphatics.