Dosimetric feasibility on hypofractionated intensity-modulated radiotherapy and simultaneous integrated boost for locally advanced unresectable pancreatic cancer with helical tomotherapy

This study aimed to review clinical experiences using whole-field simultaneous integrated boost (SIB) intensity-modulated radiotherapy (IMRT) and sequential IMRT in postoperative patients with oral cavity cancer (OCC). From November 2006 to December 2014, a total of 182 postoperative patients with OCC who underwent either SIB-IMRT (n = 63) or sequential IMRT (n = 119) were enrolled retrospectively and matched randomly according to multiple risk factors by a computer. The differences were well balanced after patient matching ( P = .38). The median follow-up time was 65 months. For patients treated with the SIB technique and the sequential technique, the respective mortality rates were 36.8% and 20.0% ( P = .04). The primary recurrence rates were 26.3% and 10.0% ( P = .02), respectively. The respective marginal failure rates were 26.7% and 16.7%. A multivariate logistic regression analysis showed that patients who received the SIB technique had a 2.74 times higher risk of death than those who received the sequential technique (95% confidence interval = 1.10-6.79, P = .03). Sequential IMRT provided a significantly lower dose to the esophagus (5.2 Gy, P = .02) and trachea (4.6 Gy, P = .03) than SIB-IMRT. For patients with locally advanced OCC, postoperative sequential IMRT may overcome an unpredictable geographic miss, potentially with a lower marginal failure rate in the primary area. Patients treated by sequential IMRT show equal overall survival benefits to those treated by SIB-IMRT and a lower mortality rate than those treated by SIB-IMRT. Additionally, a reduced dose to the esophagus and trachea compared to sequential IMRT was noted.

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Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas: II—clinical results

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2004.03.010 ◽

2004 ◽

Vol 60 (2) ◽

pp. 374-387 ◽

Cited By ~ 108

Author(s):

Andrew Lauve ◽

Monica Morris ◽

Rupert Schmidt-Ullrich ◽

Qiuwen Wu ◽

Radhe Mohan ◽

...

Keyword(s):

Head And Neck ◽

Squamous Cell ◽

Locally Advanced ◽

Intensity Modulated Radiotherapy ◽

Clinical Results ◽

Squamous Cell Carcinomas ◽

Simultaneous Integrated Boost ◽

Advanced Head ◽

Intensity Modulated ◽

Integrated Boost

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Moderately Hypofractionated Intensity Modulated Radiotherapy (IMRT) With a Simultaneous Integrated Boost for Locally Advanced Head and Cancer – Do Modern Techniques Held Their Promise?

10.21203/rs.3.rs-205189/v1 ◽

2021 ◽

Author(s):

Jörn Wichmann ◽

Martin Durisin ◽

Robert Michael Hermann ◽

Roland Merten ◽

Hans Christiansen

Keyword(s):

Locally Advanced ◽

Intensity Modulated Radiotherapy ◽

Simultaneous Integrated Boost ◽

Advanced Head ◽

Intensity Modulated ◽

Regional Control ◽

Integrated Boost ◽

Long Term Follow Up

Abstract PurposeIntensity-modulated-radiotherapy (IMRT) is still a standard of care for radiotherapy in locally advanced head and neck cancer (LA-HNSCC). Simultaneous-integrated-boost (SIB) and moderately hypofractionation offer an opportunity of individual dose painting and reduction of overall treatment time. We present retrospective data on toxicity and local-regional-control of a patient cohort with LA-HNSCC treated with an IMRT-SIB-concept in comparison to normofractionated 3D-conformal radiotherapy (3D-RT) after a long-term follow-up.MethodsBetween 2012 and 2014, n=67 patients with HNSCC (stages III/IV without distant metastases) were treated with IMRT-SIB either definitive (single/total doses: 2.2/66Gy, 2.08/62.4Gy, 1.8/54Gy in 30 fractions) or in the postoperative setting (2.08/62.4Gy, 1.92/57.6Gy, 1.8/54Gy). These patients' clinical course was matched (for gender, primary, and treatment concept) as part of a matched-pair-analysis with patients treated before mid-2012 with normofractionated 3D-CRT (definitive: 2Gy/50Gy followed by a sequential boost up to 70Gy; postoperative: 2Gy/60-64Gy). Chemotherapy/immunotherapy was given concomitantly in both groups in the definitive situation (postoperative dependent on risk factors). Primary endpoints were acute and late toxicity; secondary endpoint was loco-regional-control (LRC).Results67 patients treated with IMRT-SIB (n = 20 definitive, n = 47 adjuvant) were matched with 67 patients treated with 3D-RT. There were minor imbalances between the groups concerning non-matching-variables like extracapsular extension (ECE) and chemotherapy in IMRT-SIB.Significantly less toxicity was found in favor of IMRT-SIB concerning dysphagia, radiation dermatitis, xerostomia, fibrosis, and lymphoedema. After a median follow-up of 63 months, median LRC was not reached (IMRT-SIB) vs. 69.5m (3D-RT) (p=0.63).ConclusionThis moderately hypofractionated IMRT-SIB-concept showed to be feasible with less toxicity compared to conventional 3D-RT in this long-term follow-up observation.

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