Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: A randomized controlled trial

• Published in: Radiotherapy and oncology Vol. 104; no. 3; pp. 343 - 348
• Main Authors: Gupta, Tejpal, Agarwal, JaiPrakash, Jain, Sandeep, Phurailatpam, Reena, Kannan, Sadhana, Ghosh-Laskar, Sarbani, Murthy, Vedang, Budrukkar, Ashwini, Dinshaw, Ketayun, Prabhash, Kumar, Chaturvedi, Pankaj, D’Cruz, Anil
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.09.2012
• Subjects: 3D-CRT; Adult; Aged; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - radiotherapy; Female; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - radiotherapy; Head-neck cancer; Hematology, Oncology and Palliative Medicine; Humans; IMRT; Male; Middle Aged; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - methods; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Squamous Cell Carcinoma of Head and Neck; Subcutaneous fibrosis; Xerostomia; Subcutaneous fibrosis; Head-neck cancer; 3D-CRT; IMRT; Xerostomia
• ISSN: 0167-8140; 1879-0887; 1879-0887
• DOI: 10.1016/j.radonc.2012.07.001

To compare three-dimensional conformal radiotherapy (3D-CRT) with intensity modulated radiation therapy (IMRT) in curative-intent irradiation of head-neck squamous cell carcinoma (HNSCC). Previously untreated patients with biopsy-proven squamous carcinoma of oropharynx, larynx, or hypopharynx (T1-3, N0-2b) were randomly assigned using computer-generated permuted-block design to either 3D-CRT or IMRT, with incidence of physician-rated Radiation Therapy Oncology Group (RTOG) grade 2 or worse acute salivary gland toxicity as primary end-point. Between 2005 and 2008, 60 patients randomly allocated to either 3D-CRT (n=28 patients) or IMRT (n=32) were included and analyzed on an intention-to-treat basis. The proportion [95% confidence intervals (CI)] of patients with RTOG grade 2 or worse acute salivary gland toxicity was significantly lesser in the IMRT arm [19 of 32 patients (59%, 95%CI: 42–75%)] as compared to 3D-CRT [25 of 28 patients (89%, 95%CI: 72–97%; p=0.009)]. Late xerostomia and subcutaneous fibrosis were also significantly lesser with IMRT. There was significant recovery of salivary function over time in patients treated with IMRT (p-value for trend=0.0036). At 3-years, there were no significant differences in loco-regional control or survival between the two arms. IMRT significantly reduces the incidence and severity of xerostomia compared to 3D-CRT in curative-intent irradiation of HNSCC.