Comparative Study between Intensity Modulated Radiotherapy and Conventional Radiotherapy in Treatment of non Metastatic Squamous Cell Carcinoma of the Nasopharynx | ||
| SECI Oncology Journal | ||
| Volume 12, Issue 2, April 2024, Pages 172-190 | ||
| Abstract | ||
| Background: Carcinoma of the nasopharynx is one of the most common cancers in the head and neck areas. Control of the disease at an early stage with radiotherapy alone is usually successful. However, in loco regionally advanced disease, concurrent chemo radiotherapy is the standard treatment As regards the conventional 2dimensional radiotherapy, many studies have shown equivalent results to intensity modulated radiotherapy on the level of local, regional and distant disease control while others have reported that intensity modulated radiotherapy has improved both the overall survival and local disease control and decreased late toxicities compared to the conventional 2 dimensional radiotherapy. The aim of the study: Is to compare between intensity modulated radiotherapy and conventional 2D radiotherapy on the level of treatment outcome and treatment related morbidities in patients with non metastatic squamous cell carcinoma of the nasopharynx. Patients and methods: Patients treated by radiotherapy +/- chemotherapy from January 2013 to January 2023 in Sohag University Hospital were retrospectively enrolled and analyzed. Results: Forty one patients were identified. Twenty one (51%) were treated with intensity modulated radiotherapy while 20 (49%) were treated with conventional 2D radiotherapy. Chemotherapy was given in 33 cases (80%). No significant differences were noticed between both arms on the level of acute and chronic treatment related toxicities. The 5-y overall survival (OS), local progression free survival (LPFS) and distant progression free survival (DPFS) with conventional 2D radiotherapy and intensity modulated radiotherapy in the whole cohort were 72% versus 64%; p = 0.218 & 63% versus 85%; p = 0.220 and 77% versus 88%; p = 0.449 respectively. In univariate analysis, many significant findings were evident. Age > 51 y was associated with poorer OS in the whole cohort (p = 0.049) and also in the subgroup received chemotherapy (p = 0.047). Intensity modulated radiotherapy has significantly improved the 5-y DPFS in stage II disease (p=0.049). Chemotherapy significantly improved LPFS in advanced stages (p=0.012). Irradiation dose at 70 Gy has demonstrated significantly better OS and LPFS in advanced versus early stage (p = 0.041 and 0.012 respectively) and lastly male patients have shown significantly lower OS (p=0.041) compared to females in the older subgroup of patients. In multivariate analysis, younger age was associated with significantly better 5-y OS versus older age in the subgroup received concurrent chemo radiotherapy (HR: 0.123; 95% CI: 0.021 – 0.712 & p = 0.019). Conclusions: Although this retrospective study has enrolled a small number of patients, we conclude that in early stage of cancer nasopharynx, intensity modulated radiotherapy alone is successful and preferable than conventional radiotherapy while in advanced stages both chemotherapy (preferably, both induction and concurrent) and high dose radiation therapy should be considered. Younger ages associated with better survival outcome and, more studies are needed to improve the outcome in elderly male patients. | ||
| Keywords | ||
| Intensity modulated radiotherapy; conventional radiotherapy; carcinoma of the nasopharynx | ||
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