open access

Vol 26, No 1 (2021)
Research paper
Published online: 2021-01-22
Submitted: 2021-01-12
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Dosimetric impact of volumetric modulated arc therapy for nasopharyngeal cancer treatment

Ciro Franzese, Antonella Fogliata, Mauro Loi, Marco Badalamenti, Davide Franceschini, Tiziana Comito, Luca Cozzi, Giacomo Reggiori, Stefano Tomatis, Marta Scorsetti
DOI: 10.5603/RPOR.a2021.0017
·
Rep Pract Oncol Radiother 2021;26(1):101-110.

open access

Vol 26, No 1 (2021)
Original research articles
Published online: 2021-01-22
Submitted: 2021-01-12

Abstract

Background: The purpose of the study was to evaluate the toxicity and outcome of nasopharyngeal carcinoma patients treated using 3-dimensional conformal radiotherapy (3DCRT) or volumetric modulated arc therapy (VMAT) technique.

Materials and methods: 68 patients treated between 2006 and 2018 were retrospectively analysed. Since 2009 patients received 3DCRT with 50/70 Gy to the elective/boost volumes in 35 fractions; from then, VMAT with simultaneous integrated boost (SIB) with 54.45/69.96 Gy in 33, or 54/66 Gy in 30 fractions. Induction chemotherapy was administered in 74% of the patients, concomitant cisplatinum in 87%. Acute and late toxicity data, progression-free survival PSF and overall survival OS, and toxicity correlations with dose metrics were reported.

Results: With a median follow-up of 64 months, complete remission at the last evaluation was in 68% of the patients, while 28% and 9% had locoregional relapse and distant disease, respectively. The 5- and 10-year progression free survival (PFS) rates were 62.7±6.5% and 53.2±8.7%, respectively. The 5- and 10-year OS rates were 78.9 ± 5.5% and 61.4 ± 9.2%, respectively. At the multivariate Cox analysis TNM stage (p = 0.02) and concomitant chemotherapy (p = 0.01) resulted significant for PFS, concomitant chemotherapy (p = 0.04) for OS.

Improvements in acute toxicity were presented for VMAT patients due to its ability to spare OARs. Odds ratio (OR) for acute salivary toxicity, between VMAT and 3DCRT, was 4.67 (p = 0.02). Dosimetrically, salivary toxicity correlated with mean parotid dose (p = 0.05), dysphagia with laryngeal (p = 0.04) and mean oral cavity (p = 0.06) doses, when dose-volume histograms (DVHs) are corrected for fractionation.

Conclusion: This study is a proof of a significant benefit of the VMAT technique compared with 3DCRT in terms of side effects in nasopharynx patients, and adds dosimetric correlations.

Abstract

Background: The purpose of the study was to evaluate the toxicity and outcome of nasopharyngeal carcinoma patients treated using 3-dimensional conformal radiotherapy (3DCRT) or volumetric modulated arc therapy (VMAT) technique.

Materials and methods: 68 patients treated between 2006 and 2018 were retrospectively analysed. Since 2009 patients received 3DCRT with 50/70 Gy to the elective/boost volumes in 35 fractions; from then, VMAT with simultaneous integrated boost (SIB) with 54.45/69.96 Gy in 33, or 54/66 Gy in 30 fractions. Induction chemotherapy was administered in 74% of the patients, concomitant cisplatinum in 87%. Acute and late toxicity data, progression-free survival PSF and overall survival OS, and toxicity correlations with dose metrics were reported.

Results: With a median follow-up of 64 months, complete remission at the last evaluation was in 68% of the patients, while 28% and 9% had locoregional relapse and distant disease, respectively. The 5- and 10-year progression free survival (PFS) rates were 62.7±6.5% and 53.2±8.7%, respectively. The 5- and 10-year OS rates were 78.9 ± 5.5% and 61.4 ± 9.2%, respectively. At the multivariate Cox analysis TNM stage (p = 0.02) and concomitant chemotherapy (p = 0.01) resulted significant for PFS, concomitant chemotherapy (p = 0.04) for OS.

Improvements in acute toxicity were presented for VMAT patients due to its ability to spare OARs. Odds ratio (OR) for acute salivary toxicity, between VMAT and 3DCRT, was 4.67 (p = 0.02). Dosimetrically, salivary toxicity correlated with mean parotid dose (p = 0.05), dysphagia with laryngeal (p = 0.04) and mean oral cavity (p = 0.06) doses, when dose-volume histograms (DVHs) are corrected for fractionation.

Conclusion: This study is a proof of a significant benefit of the VMAT technique compared with 3DCRT in terms of side effects in nasopharynx patients, and adds dosimetric correlations.

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Keywords

nasopharyngeal cancer; VMAT; salivary toxicity; dysphagia

About this article
Title

Dosimetric impact of volumetric modulated arc therapy for nasopharyngeal cancer treatment

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 26, No 1 (2021)

Article type

Research paper

Pages

101-110

Published online

2021-01-22

DOI

10.5603/RPOR.a2021.0017

Bibliographic record

Rep Pract Oncol Radiother 2021;26(1):101-110.

Keywords

nasopharyngeal cancer
VMAT
salivary toxicity
dysphagia

Authors

Ciro Franzese
Antonella Fogliata
Mauro Loi
Marco Badalamenti
Davide Franceschini
Tiziana Comito
Luca Cozzi
Giacomo Reggiori
Stefano Tomatis
Marta Scorsetti

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