Intensity-Modulated Radiotherapy for Head and Neck Squamous Cell Carcinomas
Posted: Tuesday, November 27, 2018
Dose escalation with intensity-modulated radiotherapy (IMRT) did not appear to improve locoregional tumor control in patients with locally advanced head and neck squamous cell carcinomas regardless of p16 status. Data from the phase III GORTEC 2004-01 trial support the use of IMRT in this patient population. Yungan Tao, MD, PhD, of the Institut Gustave Roussy in Paris, presented these findings at the European Society for Medical Oncology (ESMO) 2018 Congress in Munich (Abstract 1054PD).
From 2005 to 2015, 188 patients with head and neck squamous cell carcinomas were randomly assigned to receive cisplatin treatment combined with either 70 Gy in 35 fractions with conventional radiotherapy or 75 Gy in 35 fractions with intensity-modulated radiotherapy. A boost of 2.5 Gy x 10 was given after administration of 50 Gy in 25 fractions to the patients in the latter group. A total of 73% of patients in the study had stage IVa cancers, and 85% had oropharyngeal cancer. In addition, Of the 160 oropharyngeal cancers, p16 status was known for 137, with about 40% testing positive for p16.
Patients were assessed after a median of 60 months. There was no significant difference in progression-free survival, locoregional tumor control, or overall survival between the two treatment groups. However, IMRT was less toxic. Xerostomia was greatly improved with IMRT, as the 1-year grade 0 to 1 salivary toxicity was 81%, compared with 34% with conventional radiotherapy.