title: Intensity-modulated radiotherapy in head and neck cancer: results of the prospective study GORTEC 2004-03.
abstract: OBJECTIVE
  In 2003, the French Authority for Health (HAS) recommended the use of intensity modulated radiotherapy (IMRT) in prospective trial before its routine use. The Oncology and Radiotherapy Group for Head and Neck Cancer (GORTEC) proposed to evaluate prospectively acute and late toxicities, locoregional control and overall survival for patients treated for head and neck cancer (HNC) with IMRT and bilateral neck irradiation.
  
  
  METHODS
  Between 2002 and 2008, 208 patients with HNC were treated with IMRT in 8 centres. There were 38 nasopharynx, 117 oropharynx, 25 pharyngo-larynx, 24 oral cavity and 4 unknown primary (28.5% stage I-II and 71% Stage III-IV). Ninety-three patients (46%) had postoperative IMRT and 78 patients (37.5%) received concurrent chemotherapy. The doses were 70 Gy to the gross tumour, 66 Gy to the high-risk postoperative sites and 50 Gy to the subclinical disease. Toxicities were graded according to the RTOG-EORTC scales.
  
  
  RESULTS
  The median follow-up was 25.3 months (range: 0.4-72 months). There were 29 local-regional failures: 24 were in-field, three were marginal and one was out-field. The two-year loco-regional control and overall survival were 86% and 86.7%, respectively. At 18 months, grade ≥ 2 xerostomia was 16.1%. A mean dose to the spared parotid below 28 Gy led to significantly less grade ≥ 2 xerostomia (8.5% vs 24%) with a relative risk of 1.2 [95% CI: 1.02-1.41, p = 0.03]. Grade ≥ 2 xerostomia increased by approximately 3% per Gy of mean parotid dose up to 28, Gy then 7% per Gy above 33 Gy.
  
  
  CONCLUSIONS
  IMRT for HN cancer seems to reduce late toxicities without jeopardising local control and overall survival.
authors.affiliation: Department of Radiation Oncology, Centre Jean Perrin, Clermont Ferrand, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Toledano
authors.forename: Pierre
authors.initials: P
authors.lastname: Graff
authors.forename: Antoine
authors.initials: A
authors.lastname: Serre
authors.forename: Pierre
authors.initials: P
authors.lastname: Boisselier
authors.forename: René-Jean
authors.initials: RJ
authors.lastname: Bensadoun
authors.forename: Cécile
authors.initials: C
authors.lastname: Ortholan
authors.forename: Pascal
authors.initials: P
authors.lastname: Pommier
authors.forename: Séverine
authors.initials: S
authors.lastname: Racadot
authors.forename: Gilles
authors.initials: G
authors.lastname: Calais
authors.forename: Marc
authors.initials: M
authors.lastname: Alfonsi
authors.forename: Veronique
authors.initials: V
authors.lastname: Favrel
authors.forename: Philippe
authors.initials: P
authors.lastname: Giraud
authors.forename: Michel
authors.initials: M
authors.lastname: Lapeyre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D014987:Xerostomia / Q000209:etiology