title: Reduced volume SIB-IMRT/IGRT to head and neck cancer in elderly and frail patients: outcome and toxicity.
abstract: BACKGROUND
  Especially elderly and frail patients have a limited ability to compensate for side effects of a radical treatment of head and neck malignancies. Limiting the target volume to the macroscopic disease, without prophylactic nodal irradiation, might present a feasible approach for these patients. The present work therefore aims evaluating an IMRT/IGRT -SIB concept for safety and efficacy.
  
  
  METHODS
  The study retrospectively enrolled 27 patients with head and neck cancers treated between 01/2012 and 05/2015. We evaluated patient files for clinical status, concomitant diseases, treatment side, and treatment volumes as well as for side effects and tumor responses. To describe efficacy and risk factors for worse outcome and higher grade toxicities, we performed cox regression analysis as well as Kaplan-Meier survival time analysis.
  
  
  RESULTS
  Median survival was 181 days, 75 % patients showed an early local response at six weeks of follow up. Most patients developed mild to moderate acute toxicities, only one patient with grade IV mucositis was seen. The grade of toxicities was correlated to the size of the PTV. Concomitant diseases, metastatic disease, and G3 Grading were indicators for worse prognosis.
  
  
  CONCLUSIONS
  The IMRT/IGRT SIB concept is a safe and feasible radiotherapy concept for patients not able or not willing to undergo radical treatment.
authors.affiliation: Department Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany. Christoph.straube@mri.tum.de.
authors.forename: Christoph
authors.identifier: http://orcid.org/0000-0002-7175-0859
authors.initials: C
authors.lastname: Straube
authors.affiliation: Department Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Steffi U
authors.initials: SU
authors.lastname: Pigorsch
authors.affiliation: Institute of Computational Biology, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Scherb
authors.affiliation: Department Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Wilkens
authors.affiliation: Department Otorhinolaryngology, Head and Neck Surgery, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Bier
authors.affiliation: Department Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.|Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D016016:Proportional Hazards Models; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome