Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a prospective cohort study

AbstractTo address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of locoregionally advanced nasopharyngeal carcinoma (LANPC) patients with induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT). We conducted a prospective study of 182 patients in the stage III to IVb with biopsy-proven nonmetastatic LANPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Occurring time of radiation-induced toxicities were estimated and compared using the Kaplan–Meier method and Log-rank test. The most severe acute toxicities included oral mucositis in 97.25% and dermatitis in 90.11%. Subset analysis revealed that Grade 3–4 acute dermatitis were significantly higher in the IMRT than 3D-CRT. Oral mucositis and dermatitis were the earliest occurrence of acute injuries (2 years: 60.44% and 17.58%). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity, but higher risk of leukopenia and gastrointestinal injury. Multivariate analyses also demonstrated that IMRT, female gender and hepatitis were the independent prognostic factors for bone marrow toxicity. In a combined regimen of IC followed by CCRT for the treatment of LANPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities, but decreased bone marrow toxicity than those treated with 3D-CRT. This study provides a comprehensive summary of prospective evidence reporting the side effects in the management of LANPC patients. We quantify the occurrence risks of chemoradiotherapy-induced acute injuries through analysis of time-to-event.

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Radiation-Induced Acute Injury of Intensity-Modulated Radiotherapy vs. Three-Dimensional Conformal Radiotherapy in Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Prospective Cohort Study

10.21203/rs.3.rs-35656/v1 ◽

2020 ◽

Author(s):

Zexin Yao ◽

Xiaoxuan Lei ◽

Zhiyan Chen ◽

Mengru Pang ◽

Jialin Huang ◽

...

Keyword(s):

Bone Marrow ◽

Concurrent Chemoradiotherapy ◽

Three Dimensional ◽

Intensity Modulated Radiotherapy ◽

Conformal Radiotherapy ◽

Acute Injury ◽

Bone Marrow Toxicity ◽

Radiation Induced ◽

Three Dimensional Conformal Radiotherapy ◽

3D Crt

Abstract Purpose: Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) was the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (LANPC). We aimed to address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of these patients.Methods: We conducted a prospective study of consecutive patients in the stage III to IVb with biopsy-proven nonmetastatic LANPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Among 182 patients included, 87 (47.80%) were treated with IMRT and 95 (52.20%) with 3D-CRT. Occurring time of radiation-induced toxicities were estimated and compared using the Kaplan-Meier method and Log-rank test. Results: The most severe acute toxicities included oral mucositis in 97.25% and dermatitis in 90.11%. Subset analysis revealed that Grade 3-4 acute dermatitis were significantly higher in the IMRT than 3D-CRT (P=0.0482). Oral mucositis and dermatitis were the earliest occurrence of acute injuries (2 years: 60.44% and 17.58%). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity (Hazard ratio [HR]= 0.426, P=0.0009), but higher risk of leukopenia (HR=1.444, P=0.0344) and gastrointestinal injury (HR=2.383, P=0.0103). Multivariate analyses also demonstrated that IMRT (HR=0.429, P=0.0211), female gender (HR=2.070, P=0.0531) and hepatitis (HR=2.152, P=0.0552) were the independent prognostic factors for bone marrow toxicity. The use of IMRT was a predictive factor of significantly better short-term efficacy, whereas anemia was a significant independent predictor.Conclusions: In a combined regimen of IC followed by CCRT for the treatment of LANPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities, but decreased bone marrow toxicity than those treated with 3D-CRT.

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Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for nasopharyngeal carcinoma: a prospective cohort study

10.21203/rs.3.rs-18506/v1 ◽

2020 ◽

Author(s):

Zexin Yao ◽

Xiaoxuan Lei ◽

Zhiyan Chen ◽

Mengru Pang ◽

Jialin Huang ◽

...

Keyword(s):

Bone Marrow ◽

Oral Mucositis ◽

Intensity Modulated Radiotherapy ◽

Progression Free Survival ◽

Conformal Radiotherapy ◽

Acute Injury ◽

Bone Marrow Toxicity ◽

Free Survival ◽

Radiation Induced ◽

3D Crt

Abstract Background: Induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) was the new standard treatment for nasopharyngeal carcinoma (NPC). We aimed to address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of these patients. Methods: We conducted a prospective study of consecutive patients with biopsy-proven nonmetastatic NPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Among the 224 patients included, 108 (48.21%) were treated with IMRT and 116 (51.78%) with 3D-CRT. Clinicians evaluated routinely acute injury each day during radiotherapy according to the Radiation Therapy Oncology Group (RTOG). Radiation-induced dermatitis, oral mucositis, bone marrow toxicity and gastrointestinal toxicity were compared using the Kaplan-Meier method and the Log-rank test. Overall survival (OS), locoregional progression-free survival (LRFS) distant metastasis-free survival (DMFS) and progression-free survival (PFS) were analyzed during standard follow-up consultations. Results: There was no difference in patient characteristics between groups; however, IMRT plans had higher docetaxel and nedaplatin compared with 3D-CRT plans. The most severe acute toxicities included oral mucositis in 96.43% and dermatitis in 88.84%. Subset analysis revealed that Grade 3-4 acute dermatitis, oral mucositis and bone marrow toxicity were not significantly lower in the IMRT than 3D-CRT (P>0.05). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity (Hazard ratio [HR]=2.557, P=0.0029) in Kaplan-Meier test, but higher risk of leukopenia (HR=0.492, P=0.0165) and gastrointestinal injury (HR=0.432, P=0.0011). Multivariate analyses also demonstrated that IMRT, male gender and hepatitis were the independent prognostic factor for bone marrow toxicity (HR=2.557, P=0.0032). No significant difference was found between the 3D-CRT and IMRT groups in terms of survival. The use of IMRT was a predictive factor of significantly better short-term efficacy, whereas anemia was a significant independent predictor. Conclusions: In a combined regimen of IC followed by CCRT for the treatment of NPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities than those treated with 3D-CRT. Predicting the occurrence time of various side effects is beneficial to early protection and focus on to coherent treatment.

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