Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients.
BACKGROUND
To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology.


METHODS
During 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45 Gy and 69.96 Gy in 33 fractions (group A); 54.45 Gy and 66 Gy in 33 fractions (group B) and 55 Gy in 25 fractions (group C).


RESULTS
Concerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition.


CONCLUSIONS
These preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities.
Istituto Clinico Humanitas IRCCS, Radiation Oncology Dept, Milan (Rozzano), Italy.
Marta
M
Scorsetti
Antonella
A
Fogliata
Simona
S
Castiglioni
Caterina
C
Bressi
Mario
M
Bignardi
Piera
P
Navarria
Pietro
P
Mancosu
Luca
L
Cozzi
Sara
S
Pentimalli
Filippo
F
Alongi
Armando
A
Santoro
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies