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Radiother Oncol. 2014 Jan;110(1):9-15. doi: 10.1016/j.radonc.2013.11.010. Epub 2013 Dec 13.

Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis.

Author information

1
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil; Radiation Oncology Department, Instituto do Câncer de São Paulo (ICESP), Brazil. Electronic address: gnmarta@uol.com.br.
2
Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil. Electronic address: v.silva@ymail.com.
3
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil; Radiation Oncology Department, Faculdade de Medicina da Universidade de São Paulo, Brazil. Electronic address: heloisa-carvalho@uol.com.br.
4
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: fer.freire@ig.com.br.
5
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: samir.hanna@hsl.org.br.
6
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: rafagadia@yahoo.com.br.
7
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: jluis@hsl.org.br.
8
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: sf.correa@uol.com.br.
9
Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: cevitabr@yahoo.com.br.
10
Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil. Electronic address: rachelriera@hotmail.com.

Abstract

BACKGROUND AND PURPOSE:

Intensity-modulated radiation therapy (IMRT) provides the possibility of dose-escalation with better normal tissue sparing. This study was performed to assess whether IMRT can improve clinical outcomes when compared with two-dimensional (2D-RT) or three-dimensional conformal radiation therapy (3D-CRT) in patients with head and neck cancer.

METHODS AND MATERIALS:

Only prospective phase III randomized trials comparing IMRT with 2D-RT or 3D-CRT were eligible. Combined surgery and/or chemotherapy were allowed. Two authors independently selected and assessed the studies regarding eligibility criteria and risk of bias.

RESULTS:

Five studies were selected. A total of 871 patients were randomly assigned for 2D-RT or 3D-CRT (437), versus IMRT (434). Most patients presented with nasopharyngeal cancers (82%), and stages III/IV (62.1%). Three studies were classified as having unclear risk and two as high risk of bias. A significant overall benefit in favor of IMRT was found (hazard ratio - HR=0.76; 95% CI: 0.66, 0.87; p<0.0001) regarding xerostomia scores grade 2-4, with similar loco-regional control and overall survival.

CONCLUSIONS:

IMRT reduces the incidence of grade 2-4 xerostomia in patients with head and neck cancers without compromising loco-regional control and overall survival.

KEYWORDS:

Head and neck cancer; Intensity-modulated radiation therapy; Three-dimensional conformal radiation therapy; Two-dimensional

PMID:
24332675
DOI:
10.1016/j.radonc.2013.11.010
[Indexed for MEDLINE]

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