A Prospective Randomized Study of Sequential Boost vs Simultaneous Integrated Boost Intensity-Modulated Radiation Therapy with Concurrent Chemotherapy in Locally Advanced Head and Neck Cancer

Abstract

Abstract Background: In modern radiotherapy era of Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT), boost of locally advanced head and neck cancer (LAHNC) can be delivered as a sequential or simultaneous integrated boost. Whether they differ in improving locoregional control or toxicity is largely unknown. In the current study, we prospectively compared two types of IMRT for non-nasopharyngeal LAHNC: sequential intensity-modulated radiation therapy (SEQ-IMRT) and simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT). Materials and Methods: Random assignment placed 66 patients with LAHNC into one of two treatment groups: SEQ-IMRT or SIB-IMRT. Patients in the SEQ-IMRT arm received a total radiotherapy (RT) dose of 70 Gy in 35 fractions over seven weeks, and the SIB-IMRT arm received 66 Gy in 30 fractions over six weeks. Concurrent weekly cisplatin 40 mg/m2 chemotherapy was given to all. Acute toxicity was evaluated in each patient once a week, and follow-up was done every three months to assess response. Results: SIB-IMRT showed a higher grade 3 or more dysphagia (45.5 percent vs. 24.2 percent, p 0.001) and higher nasogastric tube dependency. The rest of the acute toxicity profiles of both treatment arms did not show any significant difference. After a long-term follow-up of 4 years, both research arms exhibited identical progression-free (p = 0.717) and overall survival (p = 0.978) rates. Conclusion: Reduced overall treatment time and convenience in RT planning are significant advantages of SIB, especially in high-volume centers. Anticipation of higher grades of dysphagia and management of the same is necessary.