Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): To evaluate the differences in the treatment related toxicity and neutropenia rate between patients with nasopharyngeal cancer treated by IMPT and VMAT.
Materials/Methods: From December 2016 to December 2017, 27 patients receiving IMPT and 54 patients receiving VMAT for nasopharyngeal caner were propensity score-matched with 1:2 ratio. The propensity score were generated based on age, sex, T-stage, N-stage, EBV status and treatment modalities. The National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE 4.03) was used for toxicity evaluation. Chi-square test was used in the univariate analysis. Then multivariate logistic regression analysis was used in the multivariate analysis for binary toxicity endpoints.
Results: The median follow-up time was eight months. There were no imbalances between the two cohorts patients. During treatment, 6 IMPT-treated patients (22.2%) and 27 VMAT-treated patients (50%) were suffered from nasogastric tube insertion or weight loss over 8 % from baseline (OR=0.286, P=0.018). Two patients (7.4% ) in IMPT cohort and eight patients(14.8%) in VMAT cohort required NG-tube insertion. The mean duration of NG-tube placement was 2 and 6.4 weeks in the IMPT and VMAT patients respectively (P=0.318). Of the patients treating with concurrent chemoradiotherapy, there were significantly less neutropenia adverse events in IMPT group compared with VMAT group (OR=0.324, P=0.029). There were only one patient (4.2%) in IMPT group and seven patients (14.3%) in VMAT group not receiving cisplatin dose intensity over 200 mg/m2. After allowing potential confounders in multivariate analysis, IMPT treatment retained its independent association with NG-tube insertion or weight loss over 8% (P=0.049)and neutropenia adverse events (P=0.039).
Conclusion: IMPT is associated with reduced rates of NG-tube insertion or weight loss over 8% and neutropenia adverse events. The result may potentially increase treatment outcome for nasopharyngeal cancer patients treated with IMPT.
|IMPT (N =27)||VMAT (N=54)||OR (95% CI)||P value|
|NG tube during treatment, No. (%)||2 (7.4)||8 (14.8)||0.460 (0.091-2.334)||0.483|
|NG tube duration, mean (IQR), wks||6.4 (4.5-8.3)||2 (1-3)||0.318|
|Weight loss over 8%, No. (%)||5 (18.5)||22 (40.7)||0.331 (0.109-1.006)||0.051|
|Weight loss over 8% or NG tube during treatment, No. (%)||6 (22.2)||27 (50.0)||0.286 (0.100-0.819)||0.018|
|Total cisplatin dose < 200mg/m2||1 (4.2)||7 (14.3)||0.261 (0.030-2.253)||0.258|
|Neutropenia any grade||12 (50.0)||37 (75.5)||0.324(0.116-0.910)||0.029|
|Emergency Room Visit||3(11.1)||8 (14.8)||0.719 (0.174-2.961)||0.744|
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