Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas
Objective: To compare the ototoxicity and survival in head and neck carcinoma patients treated with sequential (SEQ) and simultaneous integrated boost (SIB) of volumetric modulated arc therapy (VMAT). Methods: This long-term prospective study enrolled patients with histologically confirmed head and...
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| Format: | Article |
| Language: | English |
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Galenos Yayincilik
2024-09-01
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| Series: | Turkish Archives of Otorhinolaryngology |
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| Online Access: | https://www.turkarchotolaryngol.net/articles/long-term-prospective-comparative-analysis-of-ototoxic-and-survival-outcomes-of-sequential-boost-and-simultaneous-integrated-boost-of-volumetric-modulated-arc-therapy-for-head-neck-carcinomas/doi/tao.2024.2023-10-10 |
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| author | Nidhin Das Sri Harsha Kombathula Vidhu Sharma Puneet Pareek Kapil Soni Amit Goyal |
| author_facet | Nidhin Das Sri Harsha Kombathula Vidhu Sharma Puneet Pareek Kapil Soni Amit Goyal |
| author_sort | Nidhin Das |
| collection | DOAJ |
| description | Objective: To compare the ototoxicity and survival in head and neck carcinoma patients treated with sequential (SEQ) and simultaneous integrated boost (SIB) of volumetric modulated arc therapy (VMAT).
Methods: This long-term prospective study enrolled patients with histologically confirmed head and neck carcinoma, all receiving VMAT treatment. Audiological assessments were done using various tests at baseline, two weeks, treatment completion, six months, and 12 months. The changes in bone conduction pure tone thresholds were correlated with cochlear dose, comparing SEQ and SIB plans. We also investigated other significant late toxicities that led to dysphagia, voice changes, and xerostomia. Survival was assessed with the Kaplan-Meier analysis.
Results: The study included 93 patients (186 ears), 40 receiving radiation alone and 53 undergoing chemoradiation. Baseline hearing levels for the right and left ears were 13.3±2.3 dB and 14.2±1.5 dB. After 12 months of radiation, levels were 18.5±2.4 dB and 19.11±1.9 dB, respectively. No significant changes were observed between SEQ and SIB plans, but high-frequency shifts occurred. The cochlea tolerated up to 28 Gy without hearing loss in the radiation-alone group but showed loss at 9 Gy when combined with cisplatin chemotherapy. The maximum dose (Dmax) and the mean dose (Dmean) of pharyngeal constrictor muscles predicted dysphagia. No significant SEQ vs. SIB differences were found in late toxicity or survival outcomes.
Conclusion: Modern radiotherapy techniques like VMAT adhere to cochlear dose limits. No significant differences were found between SEQ and SIB plans in sensorineural hearing loss, late toxicity, or survival, making both suitable for head and neck carcinoma treatment. |
| format | Article |
| id | doaj-art-d7a2ce6e08d2467c985bbd2738ae1e7b |
| institution | Kabale University |
| issn | 2667-7474 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Galenos Yayincilik |
| record_format | Article |
| series | Turkish Archives of Otorhinolaryngology |
| spelling | doaj-art-d7a2ce6e08d2467c985bbd2738ae1e7b2025-01-14T08:38:09ZengGalenos YayincilikTurkish Archives of Otorhinolaryngology2667-74742024-09-0162310111210.4274/tao.2024.2023-10-10Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck CarcinomasNidhin Das0https://orcid.org/0000-0002-7109-8477Sri Harsha Kombathula1https://orcid.org/0000-0003-4981-1114Vidhu Sharma2https://orcid.org/0000-0002-3547-2329Puneet Pareek3https://orcid.org/0000-0002-6055-9872Kapil Soni4https://orcid.org/0000-0002-3586-6213Amit Goyal5https://orcid.org/0000-0002-4339-7541All India Institute of Medical Sciences, Department of Otorhinolaryngology, Jodhpur, Rajasthan, IndiaConsultant Clinical Oncologist Ipswich Hospital, Ipswich, United KingdomAll India Institute of Medical Sciences, Department of Otorhinolaryngology, Jodhpur, Rajasthan, IndiaAll India Institute of Medical Sciences, Department of Radiation Oncology, Jodhpur, Rajasthan, IndiaAll India Institute of Medical Sciences, Department of Otorhinolaryngology, Jodhpur, Rajasthan, IndiaAll India Institute of Medical Sciences, Department of Otorhinolaryngology, Jodhpur, Rajasthan, IndiaObjective: To compare the ototoxicity and survival in head and neck carcinoma patients treated with sequential (SEQ) and simultaneous integrated boost (SIB) of volumetric modulated arc therapy (VMAT). Methods: This long-term prospective study enrolled patients with histologically confirmed head and neck carcinoma, all receiving VMAT treatment. Audiological assessments were done using various tests at baseline, two weeks, treatment completion, six months, and 12 months. The changes in bone conduction pure tone thresholds were correlated with cochlear dose, comparing SEQ and SIB plans. We also investigated other significant late toxicities that led to dysphagia, voice changes, and xerostomia. Survival was assessed with the Kaplan-Meier analysis. Results: The study included 93 patients (186 ears), 40 receiving radiation alone and 53 undergoing chemoradiation. Baseline hearing levels for the right and left ears were 13.3±2.3 dB and 14.2±1.5 dB. After 12 months of radiation, levels were 18.5±2.4 dB and 19.11±1.9 dB, respectively. No significant changes were observed between SEQ and SIB plans, but high-frequency shifts occurred. The cochlea tolerated up to 28 Gy without hearing loss in the radiation-alone group but showed loss at 9 Gy when combined with cisplatin chemotherapy. The maximum dose (Dmax) and the mean dose (Dmean) of pharyngeal constrictor muscles predicted dysphagia. No significant SEQ vs. SIB differences were found in late toxicity or survival outcomes. Conclusion: Modern radiotherapy techniques like VMAT adhere to cochlear dose limits. No significant differences were found between SEQ and SIB plans in sensorineural hearing loss, late toxicity, or survival, making both suitable for head and neck carcinoma treatment.https://www.turkarchotolaryngol.net/articles/long-term-prospective-comparative-analysis-of-ototoxic-and-survival-outcomes-of-sequential-boost-and-simultaneous-integrated-boost-of-volumetric-modulated-arc-therapy-for-head-neck-carcinomas/doi/tao.2024.2023-10-10head and neck cancervolumetric-modulated arc therapyradiotherapy dose fractionationototoxicitysensorineural hearing losssurvival analysis |
| spellingShingle | Nidhin Das Sri Harsha Kombathula Vidhu Sharma Puneet Pareek Kapil Soni Amit Goyal Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas Turkish Archives of Otorhinolaryngology head and neck cancer volumetric-modulated arc therapy radiotherapy dose fractionation ototoxicity sensorineural hearing loss survival analysis |
| title | Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas |
| title_full | Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas |
| title_fullStr | Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas |
| title_full_unstemmed | Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas |
| title_short | Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas |
| title_sort | long term prospective comparative analysis of ototoxic and survival outcomes of sequential boost and simultaneous integrated boost of volumetric modulated arc therapy for head neck carcinomas |
| topic | head and neck cancer volumetric-modulated arc therapy radiotherapy dose fractionation ototoxicity sensorineural hearing loss survival analysis |
| url | https://www.turkarchotolaryngol.net/articles/long-term-prospective-comparative-analysis-of-ototoxic-and-survival-outcomes-of-sequential-boost-and-simultaneous-integrated-boost-of-volumetric-modulated-arc-therapy-for-head-neck-carcinomas/doi/tao.2024.2023-10-10 |
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