title: 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.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  IMRT significantly reduces the incidence and severity of xerostomia compared to 3D-CRT in curative-intent irradiation of HNSCC.
authors.affiliation: Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India. tejpalgupta@rediffmail.com
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.forename: Jaiprakash
authors.initials: J
authors.lastname: Agarwal
authors.forename: Sandeep
authors.initials: S
authors.lastname: Jain
authors.forename: Reena
authors.initials: R
authors.lastname: Phurailatpam
authors.forename: Sadhana
authors.initials: S
authors.lastname: Kannan
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh-Laskar
authors.forename: Vedang
authors.initials: V
authors.lastname: Murthy
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.forename: Ketayun
authors.initials: K
authors.lastname: Dinshaw
authors.forename: Kumar
authors.initials: K
authors.lastname: Prabhash
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chaturvedi
authors.forename: Anil
authors.initials: A
authors.lastname: D'Cruz
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck