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Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience.
Int J Radiat Oncol Biol Phys. 2006 Jan 01; 64(1):57-62.IJ

Abstract

PURPOSE

We previously demonstrated that intensity-modulated radiation therapy (IMRT) significantly improves radiation dose distribution over three-dimensional planning for nasopharynx cancer and reported positive early clinical results. We now evaluate whether IMRT has resulted in improved outcomes for a larger cohort of patients with longer follow-up.

METHODS AND MATERIALS

Since 1998, all 74 patients with newly diagnosed, nonmetastatic nasopharynx cancer were treated with IMRT using accelerated fractionation to 70 Gy; 59 received a hyperfractionated concomitant boost, and more recently 15 received once-daily treatment with dose painting. With the exception of Stage I disease (n = 5) and patient preference (n = 1), 69 patients received concurrent and adjuvant platinum-based chemotherapy similar to that in the Intergroup 0099 trial.

RESULTS

PATIENT CHARACTERISTICS

median age 45; 32% Asian; 72% male; 65% World Health Organization III; 6% Stage I, 16% Stage II, 30% Stage III, 47% Stage IV. Median follow-up is 35 months. The 3-year actuarial rate of local control is 91%, and regional control is 93%; freedom from distant metastases, progression-free survival, and overall survival at 3 years are 78%, 67%, and 83%, respectively. There was 100% local control for Stage T1/T2 disease, compared to 83% for T3/T4 disease (p = 0.01). Six patients failed at the primary site, with median time to local tumor progression 16 months; 5 were exclusively within the 70 Gy volume, and 1 was both within and outside the target volume. There is a trend for improved local control with IMRT when compared to local control of 79% for 35 patients treated before 1998 with three-dimensional planning and chemotherapy (p = 0.11). Six months posttherapy, 21%, 13%, 15%, and 0% of patients with follow-up audiograms (n = 24 patients) had Grade 1, 2, 3, and 4 sensorineural hearing loss, respectively. For patients with >1 year follow-up (n = 59), rates of long-term xerostomia were as follows: 26% none, 42% Grade 1, 32% Grade 2, and zero Grade 3.

CONCLUSIONS

The pattern of primary site failure within the target volume suggests locally advanced T stage disease may require a higher biologic dose to gross tumor. Rates of severe (Grade 3-4) ototoxicity and xerostomia are low with IMRT as a result of normal-tissue protection. Distant metastases are now the dominant form of failure, emphasizing the need for improved systemic therapy.

Authors+Show Affiliations

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. woldens@mskcc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15936155

Citation

Wolden, Suzanne L., et al. "Intensity-modulated Radiation Therapy (IMRT) for Nasopharynx Cancer: Update of the Memorial Sloan-Kettering Experience." International Journal of Radiation Oncology, Biology, Physics, vol. 64, no. 1, 2006, pp. 57-62.
Wolden SL, Chen WC, Pfister DG, et al. Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys. 2006;64(1):57-62.
Wolden, S. L., Chen, W. C., Pfister, D. G., Kraus, D. H., Berry, S. L., & Zelefsky, M. J. (2006). Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. International Journal of Radiation Oncology, Biology, Physics, 64(1), 57-62.
Wolden SL, et al. Intensity-modulated Radiation Therapy (IMRT) for Nasopharynx Cancer: Update of the Memorial Sloan-Kettering Experience. Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):57-62. PubMed PMID: 15936155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. AU - Wolden,Suzanne L, AU - Chen,William C, AU - Pfister,David G, AU - Kraus,Dennis H, AU - Berry,Sean L, AU - Zelefsky,Michael J, Y1 - 2005/06/02/ PY - 2005/02/24/received PY - 2005/03/24/revised PY - 2005/03/24/accepted PY - 2005/6/7/pubmed PY - 2006/3/24/medline PY - 2005/6/7/entrez SP - 57 EP - 62 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 64 IS - 1 N2 - PURPOSE: We previously demonstrated that intensity-modulated radiation therapy (IMRT) significantly improves radiation dose distribution over three-dimensional planning for nasopharynx cancer and reported positive early clinical results. We now evaluate whether IMRT has resulted in improved outcomes for a larger cohort of patients with longer follow-up. METHODS AND MATERIALS: Since 1998, all 74 patients with newly diagnosed, nonmetastatic nasopharynx cancer were treated with IMRT using accelerated fractionation to 70 Gy; 59 received a hyperfractionated concomitant boost, and more recently 15 received once-daily treatment with dose painting. With the exception of Stage I disease (n = 5) and patient preference (n = 1), 69 patients received concurrent and adjuvant platinum-based chemotherapy similar to that in the Intergroup 0099 trial. RESULTS: PATIENT CHARACTERISTICS: median age 45; 32% Asian; 72% male; 65% World Health Organization III; 6% Stage I, 16% Stage II, 30% Stage III, 47% Stage IV. Median follow-up is 35 months. The 3-year actuarial rate of local control is 91%, and regional control is 93%; freedom from distant metastases, progression-free survival, and overall survival at 3 years are 78%, 67%, and 83%, respectively. There was 100% local control for Stage T1/T2 disease, compared to 83% for T3/T4 disease (p = 0.01). Six patients failed at the primary site, with median time to local tumor progression 16 months; 5 were exclusively within the 70 Gy volume, and 1 was both within and outside the target volume. There is a trend for improved local control with IMRT when compared to local control of 79% for 35 patients treated before 1998 with three-dimensional planning and chemotherapy (p = 0.11). Six months posttherapy, 21%, 13%, 15%, and 0% of patients with follow-up audiograms (n = 24 patients) had Grade 1, 2, 3, and 4 sensorineural hearing loss, respectively. For patients with >1 year follow-up (n = 59), rates of long-term xerostomia were as follows: 26% none, 42% Grade 1, 32% Grade 2, and zero Grade 3. CONCLUSIONS: The pattern of primary site failure within the target volume suggests locally advanced T stage disease may require a higher biologic dose to gross tumor. Rates of severe (Grade 3-4) ototoxicity and xerostomia are low with IMRT as a result of normal-tissue protection. Distant metastases are now the dominant form of failure, emphasizing the need for improved systemic therapy. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/15936155/Intensity_modulated_radiation_therapy__IMRT__for_nasopharynx_cancer:_update_of_the_Memorial_Sloan_Kettering_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(05)00592-4 DB - PRIME DP - Unbound Medicine ER -