(P049) Simultaneous Integrated Boost–Intensity-Modulated Radiation Treatment in Head and Neck Cancer: Outcomes From a Single-Institution Series

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OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

The main aim of this study is to assess the acute and late toxicity as well as clinical outcomes in patients with head and neck cancer treated with SIB-IMRT at a National Cancer Institute (NCI)-designated comprehensive cancer center.

Peyman Kabolizadeh, MD, PhD, Hebist Berhane, BA, Ryan P. Smith, MD, Dwight E. Heron, MD, FACRO, FACR; University of Pittsburgh Cancer Institute

Background: Locoregional (LR) failures remain a major problem in locally advanced head and neck cancers following chemoradiation. Despite aggressive combined treatment modalities for advanced head and neck cancer during the last decade, LR recurrence rate remains suboptimal. Patients are generally treated with sequentially planned radiation treatment in which the same dose is delivered to shrinking tumor volumes. Accelerated hypofractionated schedules with the simultaneous integrated boost–intensity-modulated radiotherapy (SIB-IMRT) technique have gained interest in hopes of obviating accelerated repopulation. The main aim of this study is to assess the acute and late toxicity as well as clinical outcomes in patients with head and neck cancer treated with SIB-IMRT at a National Cancer Institute (NCI)-designated comprehensive cancer center.

Materials and Methods: Between January 2005 and December 2012, 89 patients (67 males, mean age 61.4 y) with head and neck cancers were treated with definitive SIB-IMRT at the University of Pittsburgh Cancer Institute. Seventy patients (79%) received chemotherapy concurrent with radiation. The median Karnofsky performance score (KPS) at the time of treatment was 90 (range: 50–100). Kaplan-Meyer survival analyses were used to estimate local control (LC) and overall survival (OS) rates. The multivariate Cox regression method was used to model predictors of outcome.

Results: The median follow-up from SIB-IMRT was 21 months (range: 12.0–24.0 mo); 22.2% of patients had stage I/II disease, while 21.2% and 56.5% of patients had stage III and IV disease, respectively. The majority of patients had oropharyngeal (35%) and laryngeal (30%) cancer, while the remaining had oral cavity, nasopharynx, hypopharynx, and salivary cancers. The median prescription dose was 70 Gy (range: 60.0–75.6 Gy) delivered in 32 (range: 28–36) fractions. The high-risk tumor volume received a median dose of 2.18 Gy (range: 2.0–2.5 Gy) per fraction, while the intermediate-risk and low-risk tumor volumes received a median dose of 2 Gy (range: 1.8–2.25 Gy) and 1.8 Gy (range: 1.64–2.0 Gy) per fraction, respectively. The 1-/2- year LR control, OS, and distant metastases-free (DMF) survival rates were 72%/70%, 80.2%/71%, and 89%/83%, respectively. Twenty-seven patients (30%) had acute grade 3 toxicity, while none had grade 4 acute toxicity. Only two patients (3%) had grade 3 late toxicities, and no grade 4 late toxicities were noted. On univariate analysis, T-stage, and gross tumor volume (GTV) were significant predictors of local failure, while on multivariate analysis, only T-stage was a significant predictor of local failure. On univariate analysis, HPV, number of pack-years of smoking, and KPS were significant predictors of OS, while on multivariate analysis, no factors were found to be predictors of OS.

Conclusion: IMRT using SIB is an effective and safe technique in the treatment of patients with head and neck cancer, even with concurrent chemotherapy. Our results are comparable with those obtained with conventional RT. Given this, along with the inherent superior dose homogeneity and lower total number of fractions, SIB-IMRT can be offered as a standard treatment.

Acknowledgment:The project was founded by the Thomas H. Nimick, Jr. Competitive Research Fund.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment
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