title: 'Boomerang' technique: an improved method for conformal treatment of locally advanced nasopharyngeal cancer.
abstract: The primary aim of the present study was to assess radiation dosimetry and subsequent clinical outcomes in patients with locally advanced nasopharyngeal cancer using a novel radiation technique termed the 'Boomerang'. Dosimetric comparisons were made with both conventional and intensity modulated radiation therapy (IMRT) techniques. This is a study of 22 patients treated with this technique from June 1995 to October 1998. The technique used entailed delivery of 36 Gy in 18 fractions via parallel opposed fields, then 24 Gy in 12 fractions via asymmetric rotating arc fields for a total of 60 Gy in 30 fractions. Patients also received induction and concurrent chemotherapy. The radiation dosimetry was excellent. Dose-volume histograms showed that with the arc fields, 90% of the planning target volume received 94% of the prescribed dose. Relative to other conventional radiation therapy off-cord techniques, the Boomerang technique results in a 27% greater proportion of the prescribed dose being received by 90% of the planning target volume. This translates into an overall 10% greater dose received for the same prescribed dose. At 3 years, the actuarial loco-regional control rate, the failure-free survival rate and the overall survival rate were 91, 75 and 91%, respectively. At 5 years, the actuarial loco-regional control rate, the failure-free survival rate and the overall survival rate were 74, 62 and 71%, respectively. The Boomerang technique provided excellent radiation dosimetry with correspondingly good loco-regional control rates (in conjunction with chemotherapy) and very acceptable acute and late toxicity profiles. Because treatment can be delivered with conventional standard treatment planning and delivery systems, it is a validated treatment option for centres that do not have the capability or capacity for IMRT. A derivative of the Boomerang technique, excluding the parallel opposed component, is now our standard for patients with locally advanced nasopharyngeal cancer when IMRT is not available.
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Institute, St Andrews Place, Melbourne, Victoria, Australia. June.Corry@petermac.org
authors.forename: June
authors.initials: J
authors.lastname: Corry
authors.forename: Colin
authors.initials: C
authors.lastname: Hornby
authors.forename: Richard
authors.initials: R
authors.lastname: Fisher
authors.forename: Ieta
authors.initials: I
authors.lastname: D'Costa
authors.forename: Sandro
authors.initials: S
authors.lastname: Porceddu
authors.forename: Danny
authors.initials: D
authors.lastname: Rischin
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D016896:Treatment Outcome