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Acute toxicity of concomitant boost radiation therapy by volumetric-modulated arc therapy in head and neck cancers

Published online by Cambridge University Press:  17 August 2017

Kannan Perisamy ,
Ashutosh Mukherji ,
Saravanan Kandasamy  and
K. Sathyanarayan Reddy
Kannan Perisamy
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Ashutosh Mukherji*
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Saravanan Kandasamy
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
K. Sathyanarayan Reddy
Affiliation:
Department of Oncology, Mahatma Gandhi Medical College and Research Centre, Puducherry, India
*
Correspondence to: Dr Ashutosh Mukherji, Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry 605006, India. Tel: 09 489 146 747. E-mail: drashutoshm@gmail.com
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Abstract

Introduction

Volumetric-modulated arc therapy (VMAT) is an advanced form of intensity-modulated radiation therapy that reduces treatment time without compromising plan quality. This study assessed acute toxicities in patients having carcinomas of oropharynx, larynx and hypopharynx treated with concomitant boost radiation therapy by VMAT.

Materials and methods

In this study, 30 patients of stages II–IVA disease were treated with concomitant boost radiation therapy using VMAT and those with stages III and IV also received concurrent chemotherapy with cisplatin 100 mg/m2 weekly thrice for two cycles. The total dose was 68·4 Gy/40 fractions/5.5 weeks (1·8 Gy/fraction/day to the large field for 28 fractions +1·5 Gy/fraction/day to boost field for the last 12 days of treatment). Radiation Therapy Oncology Group acute radiation morbidity scoring criteria was used to grade acute effects.

Results

All patients completed scheduled treatment with median duration of 44 days. No grade 4 skin and mucosal toxicities were observed; grade 3 skin and mucosal toxicities seen in six (20%) and eight (26·67%) patients, respectively; grade 3 dysphagia and laryngeal toxicity in eight (26·67%) and three (10%) patients, respectively; two patients had grade 4 laryngeal toxicity. No grade 3 or grade 4 haematological toxicities were seen.

Conclusion

VMAT-based concomitant boost radiation therapy allows for dose escalation with good patient tolerance by limiting acute toxicities.

Keywords

acute chemo-radiation toxicitiesaltered fractionationconcomitant boost radiation therapy with volumetric arc IMRThead and neck cancersvolumetric arc therapy in head and cancers
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 4 , December 2017 , pp. 423 - 430
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Copyright
© Cambridge University Press 2017 

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