Intensity-Modulated Radiation Therapy in Head-and-Neck Cancer, First Report in Thailand
Chawalit Lertbutsayanukul MD*, Chonlakiet Khorprasert MD*, Kanjana Shotelersuk MD*, Chotika Jumpangern MSc**, Taweap Sanghangthum MSc**, Sornjarod Oonsiri MSc**, Isra Israngkul Na Ayuthaya MSc**, Sivalee Suriyapee MEng*, Winai Wadwongtham MD***, Siripornchai Supanakorn MD***, Virachai Kerekanjanarong MD***, Prayuth Rojpornpradit MD*
Affiliation : * Division of Radiation Oncology, Department of Radiology,Faculty of Medicine, Chulalongkorn University ** Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital *** Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University
Objective : This is the first report in Thailand to evaluate the efficacy of using intensity-modulated radio-
therapy (IMRT) in the primary treatment of head-and-neck cancer.
Materials and Methods : From July 2005 to March 2006, eighteen patients with head and neck cancer were
treated with IMRT, fourteen of which were nasopharyngeal cancer. The median age at diagnosis was 52 years
(range 23-58 years). The treatment plan composed of two sequential plans for PTV-low risk (50Gy in 25
fractions) and PTV-high risk (20Gy in 10 fractions). Chemotherapy was given to 13 patients with locoregionally
advanced disease (stage T3/T4 and N2/3) using cisplatin (n = 3) or carboplatin (n = 10) every 3 weeks during
the course of radiation therapy.
Results : The median overall treatment time was 49 days (range, 43-57 days), and 77.8 percent of the patients
completed 35 fractions within 50 days. The clinical complete response and partial response rates at 3 months
after complete radiation were 71.4% and 28.6%, respectively. However, at the median follow-up of 5.6 months,
the complete response rate increased to 89%. Treatment break during RT, range from 3 to 7 days, was observed
in three patients. All of them received concurrent chemoradiation. No distant metastasis was noted.
Conclusion : The authors’ experience of using concurrent chemotherapy with IMRT for a cohort of patients
with head and neck carcinoma showed a very high rate response rate at early follow-up. Long-term clinical
outcome is expected.
Keywords : Intensity-modulated radiation therapy, Head neck cancer, IMRT
