IMRT for Head and Neck Cancer: Updated Clinical Results

S. Jack Wei, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 22, 2003

Moderator: Theodore L. Phillips, MD., University of California, San Francisco

Nancy Lee, MD, Memorial Sloan-Kettering Cancer Center, New York

  • Approximately 150 papers have reported on the outcomes of H&N cancer patients treated with IMRT.
  • The primary endpoints for these trials usually are rates of xerostomia and local control.
  • It is important to keep in mind that GTV delineation is a multidisciplinary approach requiring the input of the radiation oncologist, neuroradiologist, and the H&N surgeon.
  • CTV delineation requires knowledge of H&N anatomy and patterns of spread.
  • In terms of xerostomia, mean parotid doses of <26 Gy has resulted in objective and subjective salivary function preservation and improved quality of life.
  • IMRT has resulted in 82% improvement in xerostomia at 12 months compared to 40% improvement with 3DCRT.
  • In terms of local control (LC) in nasopharyngeal cancer, comparison to historical controls have shown the following:
  • For T1-2 lesions, IMRT 92-100% vs. 3DCRT 64-95%
  • For T3-4 lesions, IMRT 92-94% vs. 44-68%
  • For oropharyngeal CA, comparison to historical controls for LC have shown:
  • For T1-2 lesions, IMRT 92% vs. 3DCRT 70-90%
  • For T3-4 lesions, IMRT 87-94% vs. 3DCRT 30-70%
  • Similar high rates of LC are seen for other H&N sites.
  • In conclusion, IMRT has been shown to decrease xerostomia rates and possibly increase local control compared to historical controls, particularly in patients with more advanced disease.
  • These patients may experience higher acute toxicity and likely have an increased risk of second malignancy (from 1% to 1.75%) due to the higher integral dose delivered with IMRT.
  • Although randomized trials would be beneficial, it would be difficult to enroll patients into these studies given the existing, non-randomized data.
  • Two ongoing European trials are currently examining these questions, and the results are eagerly anticipated.

Blogs

Is Ayurveda the Answer to Women’s Health Issues?
by The 4Wholeness Team
September 01, 2015