A prospective randomized study of sequential boost versus simultaneous integrated boost intensity-modulated radiation therapy with concurrent chemotherapy in locally advanced head and neck cancer.

Abstract

Purpose: Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy can lessen side effects from treatment and are currently the standard of care for locally advanced head and neck cancer (LAHNC). The boost radiation can be delivered as a sequential or simultaneous integrated boost. Whether they differ in improving locoregional control or toxicity is largely unknown. In the current study, we prospectively compared two types of IMRT for non-nasopharyngeal LAHNC: sequential IMRT (SEQ-IMRT) and simultaneous integrated boost IMRT (SIB-IMRT).

Materials and methods: Random assignment placed 66 patients with LAHNC into one of two treatment groups: SEQ-IMRT or SIB-IMRT. Patients in the SEQ-IMRT arm received a total radiotherapy (RT) dose of 70 Gy in 35 fractions over 7 weeks, and the SIB-IMRT arm received 66 Gy in 30 fractions over 6 weeks. Concurrent weekly cisplatin 40 mg/m2 chemotherapy was given to all. Acute toxicity was evaluated in each patient once a week, and follow-up was done every 3 months to assess response.

Results: SIB-IMRT showed a higher grade 3 or more dysphagia (45.5% vs. 24.2%, P 0.001) and higher nasogastric tube dependency. The rest of the acute toxicity profiles of both treatment arms did not show any significant difference. After a long-term follow-up of 4 years, both research arms exhibited identical progression-free (P = 0.855) and overall survival (P = 0.554) rates.

Conclusion: Reduced overall treatment time and convenience in RT planning are significant advantages of SIB, especially in high-volume centers. Anticipation of higher grades of dysphagia and management of the same is necessary.