Title: Comparison of acute toxicities in patients of Head and Neck Cancer treated by 3D-CRT v/s IMRT
Authors: Neha Rawat, H. S. Kumar, Neeti Sharma, Shankar Lal Jakhar, Rahul Kumar Rai, Narendra Kumar Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.130
Abstract
Background: Radiotherapy plays a critical role in the management of many patients with head and neck cancer. In recent decades, the treatment for head and neck cancer has moved from two-dimensional radiotherapy to three-dimensional conformal radiotherapy (3D-CRT) and recently also to intensity-modulated radiotherapy (IMRT). In this study we aim to demonstrate difference of toxicity profile between 3D-CRT and IMRT in patients of head and neck cancer.
Material and Methods: A total of 60 patients of head and neck cancer were randomly selected divided into two groups of 30 patients in each. Patients of group A received 3D-CRT and group B received IMRT. Patients of both arms received concurrent chemoradiation, were assessed weekly for local disease response & development of any acute skin or mucosal reactions. Xerostomia was assessed at the end of treatment, 1 month, 3 month and 6 month post radiotherapy. Xerostomia was also assessed and graded as per the CTCAE guidelines at 6 months follow up after treatment completion.
Results: The median age in the 3D-CRT arm was 50.5 years with range of 21 to 70 years while the median age in IMRT arm was 38 years with range of 18 to 64 years. Male patients were more common in both arms than female patients (90% in 3D-CRT arm and 80% in IMRT arm). In 3D-CRT arm 83.3% patients and in IMRT arm 76.6% patients suffered from grade II acute skin reactions during treatment duration or at the end of treatment. In 3D-CRT arm 80% patients were with grade II and 10% patients were with grade III acute stomatitis while in IMRT arm 86.6% patients were with grade II and no patient was with grade III acute stomatitis during treatment or at end of treatment. There was no statistically significant difference in incidence and severity of both acute skin reaction and stomatitis during or at the end of treatment in both arms. At the end of treatment, 1 month, 3 month and 6 month post radiotherapy there was no significant difference in incidence or RTOG grade of xerostomia between both the arms. While on assessing with CTCAE criteria there was significant difference in occurrence of grade III xerostomia at 6 months post radiotherapy between the two arms (63.3% in 3D-CRT arm v/s 30% in IMRT arm, p value = 0.009). There was no significant difference in the two arms in respect to treatment respone
Conclusion: This study concluded that there was no significant difference in acute skin toxicity and stomatitis in head and neck cancer patients treated by either 3D-CRT or IMRT but there was significant difference in occurrence of higher grade xeostomia at 6 months in favor of IMRT. So, IMRT should be considered in treatment of head nand neck cancers to prevent higher grade xerostomia.
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