Early clinical outcomes of helical Tomotherapy/ intensity modulated proton therapy combination in nasopharynx cancer.

Thu Jun 27, 2019 14:59

by Park SG, Ahn YC, Oh D, Noh JM, Ju SG, Kwon D, Jo K, Chung K, Chung E, Lee W, Park S via pubmed cancer sci [jour]

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Early clinical outcomes of helical Tomotherapy/ intensity modulated proton therapy combination in nasopharynx cancer.
Cancer Sci. 2019 Jun 25;:
Authors: Park SG, Ahn YC, Oh D, Noh JM, Ju SG, Kwon D, Jo K, Chung K, Chung E, Lee W, Park S
Abstract
This study aimed to evaluate the feasibility of combining helical Tomotherapy (HT) and intensity-modulated proton therapy (IMPT) in treating the patients with nasopharynx cancer (NPC). From January 2016 till March 2018, 98 patients received definitive radiation therapy (RT) with concurrent chemotherapy (CCRT). Using simultaneous integrated boost and adaptive re-plan, 3 different dose levels were prescribed: 68.4 Gy in 30 fractions to GTV, 60 Gy in 30 fractions to high-risk CTV, and 36 Gy in 18 fractions to low-risk CTV. In all patients, the initial 18 fractions were delivered by HT, and, after rival plan evaluation on the adaptive re-plan, the later 12 fractions were delivered either by HT in 63 patients (64.3%, HT only) or IMPT in 35 patients (35.7%, HT/IMPT combination), respectively. Propensity score matching was conducted to control differences of patients' characteristics. In all patients, grade ≥2 mucositis (69.8% vs 45.7%, p=.019) and grade ≥2 analgesic usage (54% vs 37.1%, p=.110) were less frequent in HT/IMPT group. In matched patients, grade ≥2 mucositis were still less frequent numerically in HT/IMPT group (62.9% vs 45.7%, p=.150). In univariate analysis, stage IV disease and larger GTV volume were associated with more grade ≥2 mucositis. There was no significant factor in multivariate analysis. With the median 14 months' follow-up, locoregional and distant failures occurred in 9 (9.2%) and 12 (12.2%) patients without difference by RT modality. In conclusion, comparable early oncologic outcomes with more favorable acute toxicity profiles were achievable by HT/IMPT combination in treating NPC patients. This article is protected by copyright. All rights reserved.
PMID: 31237050 [PubMed - as supplied by publisher]