How Safe Are Reduced Doses per Fraction in Target Volumes of 2nd to 4th Order in the Simultaneous Integrated Boost Irradiation Technique in Head and Neck Carcinoma PatientsReportar como inadecuado




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Aim: The simultaneous irradiation oftarget volumes of different total dose levels using intensity modulatedradiotherapy leads to reduced doses per fraction and longer treatment times intarget volumes of 2nd to4th order. Does thethereby caused reduced biological effectiveness induce an increased recurrencerisk? The current work deals with the problem of recurrences of patients withhead and neck carcinomas treated either with an intensitiy IMRT or with avolumetric modulated VMAT irradiation technique. Methods: From October 2002to September 2014, 699 patients with carcinomas of the head and neck wereirradiated using IMRT or VMAT. The median follow up of the patients was 21.9months 2 to 145 months. Primary tumor regions 1st order target volume of 565 patientswere treated with doses per fraction of 2 Gy. Accordingly, further 133 targetvolumes of the primary tumor received reduced doses per fraction. In 1 patient,the lymphatic drainage was treated solely without irradiation of the primaryregion. For the lympatic drainage, 854 1st order target volumes were treated witha dose per fraction of 2 Gy. Reduced doses per fraction were applied to further1780 target volumes. Results: 54 of 699 patients developed a recurrence in theprimary tumor region after radio-chemo therapy, 4 patients developed arecurrence of the primary tumor and a unilateral recurrence of the lymphaticdrainage, 2 patients a recurrence of the primary tumor and a bilateral lymphnode recurrence. 18 patients showed an isolated unilateral recurrence andadditionally 2 patients a bilateral recurrence of the lymphatic drainage. 619patients stayed recurrence free. In primary tumor regions, receiving a dose perfraction of 2 Gy 55 patients 9.7% developed a recurrence, whereas in targetvolumes receiving a reduced dose per fraction 5 patients 3.8% developed arecurrence p < 0.001. In lympatic drainage target volumes receiving a doseper fraction of 2 Gy, 25 target volumes 2.9% developed a recurrence, whereasin target volumes receiving a reduced dose per fraction, 5 patients 0.3%developed a recurrence p = 0.001. Conclusion: The recurrence risk in targetvolumes of 2nd to 4th order was not increased due to reduceddoses per fraction deposited by means of a simultaneous integrated boosttechnique. Therefore, the simultaneous irradiation of target volumes withdifferent dose levels is safely applicable within one treatment plan.



KEYWORDS

Head and Neck Carcinoma, Simultaneous Integrated Boost Technique, Dose Painting, Dose per Fraction, Recurrence Risk

Cite this paper

Buchali, A. , Schroeder, C. , Boerrnert, C. , Maekelburg, I. , Huhnt, W. and Franzen, A. 2015 How Safe Are Reduced Doses per Fraction in Target Volumes of 2nd to 4th Order in the Simultaneous Integrated Boost Irradiation Technique in Head and Neck Carcinoma Patients?. Journal of Cancer Therapy, 6, 213-221. doi: 10.4236-jct.2015.62023.





Autor: A. Buchali1*, C. Schroeder1,2, C. Boerrnert1, I. Maekelburg1, W. Huhnt1, A. Franzen3

Fuente: http://www.scirp.org/



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