Grover Akanksha, Soni Tej Prakash, Patni Nidhi, Singh Dinesh Kumar, Jakhotia Naresh, Gupta Anil Kumar, Sharma Lalit Mohan, Sharma Shantanu, Gothwal Ravindra Singh
Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India.
Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India.
Radiat Oncol J. 2021 Mar;39(1):15-23. doi: 10.3857/roj.2020.01018. Epub 2021 Mar 18.
Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IMRT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer.
Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm's patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy.
Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783).
Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.
调强放射治疗（IMRT）可提高靶区剂量并限制正常组织受量。IMRT可采用同步整合加量（SIB-IMRT）或序贯加量（SEQ-IMRT）技术。本研究的目的是比较SIB-IMRT和SEQ-IMRT在局部晚期头颈癌患者中的急性毒性和客观缓解率。
110例局部晚期口咽癌、下咽癌和喉癌患者被平均随机分为两组（SIB-IMRT组与SEQ-IMRT组）。SIB-IMRT组患者在6周内每周5天接受30次分割，总剂量66 Gy。SEQ-IMRT组患者在7周内接受35次分割，总剂量70 Gy。两组均给予每周同步顺铂化疗。在治疗期间评估患者的急性毒性，并在放疗后3个月评估客观缓解情况。
与SEQ-IMRT相比，SIB-IMRT组3级吞咽困难明显更多（72%对41.2%；p = 0.006），但两组其他毒性包括黏膜炎、皮炎、口干、体重减轻、鼻胃管插管发生率及支持治疗住院率相似。与SEQ-IMRT组相比，SIB-IMRT组患者治疗依从性更好，治疗中断明显更少（p = 0.028）。两组客观缓解率相似（p = 0.783）。
与SEQ-IMRT相比，SIB-IMRT同步放化疗治疗局部晚期头颈癌耐受性良好，治疗依从性更好，客观缓解率相似，黏膜炎发生率相当，但3级吞咽困难发生率更高。
