Tandon Sarthak, Gairola Munish, Ahlawat Parveen, Rawat Sheh, Aggarwal Archana, Sharma Kanika, Tiwari Sandeep, Karimi Ahmad M, Muttagi Vinayakumar, Sachdeva Nishtha, Bhushan Manindra
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085, India.
Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085, India.
J Egypt Natl Canc Inst. 2018 Sep;30(3):107-115. doi: 10.1016/j.jnci.2018.06.001. Epub 2018 Jun 28.
Comparison of two fractionation schedules of intensity modulated radiotherapy (IMRT) for locally advanced head and neck cancer - simultaneous integrated boost (SIB-IMRT) and simultaneous modulated accelerated radiotherapy (SMART) boost in terms of toxicity and survival end-point measures.
Sixty patients with locally advanced head and neck cancer were randomized in two treatment arms (SIB-IMRT [control arm] and SMART boost arm [study arm]). In the control arm, patients received 70, 63 and 56 Gy in 35 fractions to clinical target volumes (CTV) 1, 2 and 3, respectively. In the study arm, patients received 60 and 50 Gy to CTV 1 and CTV 3, respectively. Toxicities, progression free survival (PFS) and overall survival (OS) were compared between both arms.
Baseline patient-related characteristics were comparable between the arms except for primary site of tumour. No significant differences were noted in acute toxicities between the arms except for fatigue which was statistically higher for control arm. No significant differences in 2-year late toxicities were observed. The median follow-up duration was 25.5 (range, 1.8-39.9) months. The 2-year PFS was 53.3% and 80.0% (p = 0.028) for control and study arm, respectively. The 2-year OS was 60.0% and 86.7% (p = 0.020) in control and study arms, respectively. Multivariate analysis showed clinical stage and site to be significant predictors for OS and PFS, respectively.
The SMART boost technique can be a feasible alternative fractionation schedule that reduces the overall treatment time, maintaining comparable toxicity and survival compared with SIB-IMRT.
比较局部晚期头颈癌调强放射治疗（IMRT）的两种分割方案——同步整合加量（SIB-IMRT）和同步调制加速放疗（SMART）加量在毒性和生存终点指标方面的差异。
60例局部晚期头颈癌患者被随机分为两个治疗组（SIB-IMRT组[对照组]和SMART加量组[研究组]）。对照组患者分别接受35次分割，给予临床靶区（CTV）1、2和3的剂量为70、63和56 Gy。研究组患者分别给予CTV 1和CTV 3的剂量为60和50 Gy。比较两组的毒性、无进展生存期（PFS）和总生存期（OS）。
除肿瘤原发部位外，两组患者的基线相关特征具有可比性。两组急性毒性反应无显著差异，但对照组疲劳发生率在统计学上更高。2年晚期毒性反应无显著差异。中位随访时间为25.5（范围1.8 - 39.9）个月。对照组和研究组的2年PFS分别为53.3%和80.0%（p = 0.028）。对照组和研究组的2年OS分别为60.0%和86.7%（p = 0.020）。多因素分析显示，临床分期和部位分别是OS和PFS的显著预测因素。
与SIB-IMRT相比，SMART加量技术是一种可行的替代分割方案，可缩短总治疗时间，同时保持相当的毒性和生存率。
