title: Acute toxicity in nasopharyngeal carcinoma patients treated with IMRT/VMAT.
abstract: OBJECTIVE
  To evaluate acute toxicity in nasopharyngeal cancer (NPC) patients treated with intensity modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) with or without cisplatin-based chemotherapy.
  
  
  METHODS
  A total of 45 newly diagnosed, histologically proven non-metastatic NPC patients treated with IMRT between May 2010 and December 2012, were evaluated retrospectively, 37 planned with Eclipse and 8 with Prowess Panther treatment planning system. The doses to the planning target volumes of primary tumor and involved lymph nodes, high risk region, and uninvolved regional nodal areas were 70 Gy, 60 Gy, and 54 Gy respectively and delivered simultaneously over 33 fractions to 39 patients. Another 6 patients irradiated with sequential boost technique. Some 84.4% of patients received chemotherapy. Acute toxicities were graded according to the Radiation Therapy Oncology Group scoring criteria and Common Terminology Criteria for Adverse Events (CTCAE) for chemotherapy side effects.
  
  
  RESULTS
  Median age was 43 years (14-79) and all patients were WHO type II. Grade 1 mucositis and dysphagia were observed in 17 (37.8%), and 10 (22.2%) patients, respectively. The incidence of acute grade 2 mucositis and dysphagia was 55.6% and 68.9%, respectively. The most common chemoradiotherapy related acute toxicities were nausea, leucopenia and thrombocytopenia. Grade 3 toxicity was detected in 13 (28.8%) cases. No grade 4 toxicity was occurred. Mean weight loss was 9%. None of the patients required the insertion of percutaneous endoscopic gastrostomy for nutritional support. Radiation therapy was completed without interruption in all patients.
  
  
  CONCLUSIONS
  IMRT is a safe and effective treatment modality, and well tolerated by patients in the treatment of nasopharyngeal carcinoma. No unexpected side effects were observed.
authors.affiliation: Department of Radiation Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey E-mail : drsozdem@hotmail.com.
authors.forename: Sevim
authors.initials: S
authors.lastname: Ozdemir
authors.forename: Mustafa
authors.initials: M
authors.lastname: Akin
authors.forename: Yasin
authors.initials: Y
authors.lastname: Coban
authors.forename: Cumhur
authors.initials: C
authors.lastname: Yildirim
authors.forename: Omer
authors.initials: O
authors.lastname: Uzel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002277:Carcinoma; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000453:epidemiology; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D009325:Nausea / Q000453:epidemiology; D011832:Radiation Injuries / Q000473:pathology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin