Acute hematologic and mucosal toxicities in head and neck cancer patients undergoing chemoradiotherapy: A comparison of 3D-CRT, IMRT, and helical tomotherapy

Tim J. Kruser, Stephanie R. Rice, Kevin P. Cleary, Heather M. Geye, Wolfgang A. Tome, Paul M. Harari, Kevin R. Kozak

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

IMRT and helical tomotherapy for head and neck cancer (HNC) treatment are associated with higher doses to certain non-target tissues than traditional static beam techniques. We hypothesized that this may lead to higher acute mucosal and hematologic toxicities. This analysis was limited to 178 patients receiving ≥60 Gy with concurrent weekly cisplatin. Radiation delivery used 3D-CRT in 41 patients (23%), conventional IMRT in 56 patients (31%), and helical tomotherapy in 81 patients (46%). Acute mucositis rates, weekly hematologic parameters, and ability to deliver planned chemotherapy cycles were examined for each patient during their course of chemoradiotherapy. Analysis showed patients were well balanced with regard to sex, age, and stage. Treatment time, as assessed by delivered monitor units, varied significantly between the 3D-CRT (median = 502), IMRT (median= 1087), and tomotherapy (median = 6757) cohorts. Acute mucositis grades did not significantly differ between the three subsets. Through six weeks of chemoradiotherapy, the median decline in hemoglobin was 15.6%, the median decline in platelets was 30.6%, and the median decline in leukocytes was 51.5%, but these drops were not significantly different between treatment cohorts. Chemotherapy was discontinued or held secondary to hematologic toxicity in 12% of 3D-CRT patients, 5% of IMRT patients and 15% of tomotherapy patients (p = 0.14). In conclusion, HNC patients undergoing high dose radiation with concurrent weekly cisplatin chemotherapy, the longer beam-on times and larger volumes of low-to-moderate radiation doses to non-target tissues associated with modern IMRT delivery techniques do not appear to result in increased acute hematologic or mucosal toxicities.

Original languageEnglish (US)
Pages (from-to)383-389
Number of pages7
JournalTechnology in Cancer Research and Treatment
Volume12
Issue number5
DOIs
StatePublished - Oct 2013

Fingerprint

Intensity-Modulated Radiotherapy
Chemoradiotherapy
Head and Neck Neoplasms
Mucositis
Radiation
Drug Therapy
Cisplatin
Hemoglobins
Leukocytes
Therapeutics
Blood Platelets

Keywords

  • Head and neck cancer
  • Helical tomotherapy
  • IMRT
  • Mucositis
  • Neutropenia

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Acute hematologic and mucosal toxicities in head and neck cancer patients undergoing chemoradiotherapy : A comparison of 3D-CRT, IMRT, and helical tomotherapy. / Kruser, Tim J.; Rice, Stephanie R.; Cleary, Kevin P.; Geye, Heather M.; Tome, Wolfgang A.; Harari, Paul M.; Kozak, Kevin R.

In: Technology in Cancer Research and Treatment, Vol. 12, No. 5, 10.2013, p. 383-389.

Research output: Contribution to journalArticle

Kruser, Tim J. ; Rice, Stephanie R. ; Cleary, Kevin P. ; Geye, Heather M. ; Tome, Wolfgang A. ; Harari, Paul M. ; Kozak, Kevin R. / Acute hematologic and mucosal toxicities in head and neck cancer patients undergoing chemoradiotherapy : A comparison of 3D-CRT, IMRT, and helical tomotherapy. In: Technology in Cancer Research and Treatment. 2013 ; Vol. 12, No. 5. pp. 383-389.
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abstract = "IMRT and helical tomotherapy for head and neck cancer (HNC) treatment are associated with higher doses to certain non-target tissues than traditional static beam techniques. We hypothesized that this may lead to higher acute mucosal and hematologic toxicities. This analysis was limited to 178 patients receiving ≥60 Gy with concurrent weekly cisplatin. Radiation delivery used 3D-CRT in 41 patients (23{\%}), conventional IMRT in 56 patients (31{\%}), and helical tomotherapy in 81 patients (46{\%}). Acute mucositis rates, weekly hematologic parameters, and ability to deliver planned chemotherapy cycles were examined for each patient during their course of chemoradiotherapy. Analysis showed patients were well balanced with regard to sex, age, and stage. Treatment time, as assessed by delivered monitor units, varied significantly between the 3D-CRT (median = 502), IMRT (median= 1087), and tomotherapy (median = 6757) cohorts. Acute mucositis grades did not significantly differ between the three subsets. Through six weeks of chemoradiotherapy, the median decline in hemoglobin was 15.6{\%}, the median decline in platelets was 30.6{\%}, and the median decline in leukocytes was 51.5{\%}, but these drops were not significantly different between treatment cohorts. Chemotherapy was discontinued or held secondary to hematologic toxicity in 12{\%} of 3D-CRT patients, 5{\%} of IMRT patients and 15{\%} of tomotherapy patients (p = 0.14). In conclusion, HNC patients undergoing high dose radiation with concurrent weekly cisplatin chemotherapy, the longer beam-on times and larger volumes of low-to-moderate radiation doses to non-target tissues associated with modern IMRT delivery techniques do not appear to result in increased acute hematologic or mucosal toxicities.",
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