Prospective Study Comparing Acute Toxicity and Objective Response Rate between Simultaneous Integrated Boost and Sequential Boost Intensity-Modulated Radiation Therapy for Locally Advanced Head and Neck Squamous Cell Carcinoma

Purpose Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) were included for evaluation of patient’s characteristics, dosimetric analysis and plan evaluation of both intensity-modulated radiotherapy (RT) using simultaneous integrated boost (SIB-IMRT) and sequential IMRT (IMRTSEQ) and compare the response and acute toxicity of both arms. Materials and Methods This prospective single blind randomized clinical comparative study was carried out on 60 patients, clinically and histologically confirmed of locally advanced HNSCC at Clinical Oncology Department, Tanta University Hospitals. All patients were randomly divided into two equal groups: Group A was treated with SEQ-IMRT and group B was treated with SIB-IMRT. All patients received 3 cycles induction chemotherapy with (Docetaxel or Taxotere), Platinum and 5-fluorouracil followed by concurrent chemo RT with cisplatin or carboplatin. Results Performance status 2; Organ at risk (OAR) was higher for group B (63.6%) vs. (18.2%), (p = .030). post cricoid subsite, OAR was higher for group B (100%) vs. (33.3%) for group A, (p = 0.035). For N2 patients, OAR was higher in group B (66.7%) than group A (35%), (p = 0.043) with CR was in (33% vs. 20%)) for group B &A respectively, (p = 0.241). Conclusion The SIB-IMRT arm, with shorter total treatment duration, resulted in comparable treatment outcomes and acute toxicity rates. This reduction in treatment time not only reduces costs but also decreases the workload of busy radiation. The SIB-IMRT is well-tolerated with better treatment-compliance for head and neck cancer patients.