Clinical outcomes of several IMRT techniques for patients with head and neck cancer: A propensity score weighted analysis
Menée auprès de 166 patients atteints d'un cancer de la cavité buccale, de l'oropharynx ou du rhinopharynx, cette étude française compare, du point de vue du taux de contrôle loco-régional à 18 mois, de la survie sans progression, de la survie spécifique et de la survie globale, l'efficacité de deux techniques de radiothérapie avec modulation d'intensité : la tomothérapie (radiothérapie hélicoïdale) et l'Arc Thérapie
Purpose : The ART-ORL study (NCTXXXXXX) was performed to prospectively evaluate the clinical and economic aspects of Helical Tomotherapy® and Volumetric Modulated Arc Therapy RapidArc® for patients with head and neck cancer. Materials and methods : Fourteen centers participated in this prospective comparative study. Randomization was not possible due to the availability of equipment. Patients with epidermoid or undifferentiated nasopharyngeal carcinoma, epidermoid carcinoma of oropharynx and oral cavity (T1-T4, M0, N0-N3) were included between February 2010 and February 2012. Only the results of the clinical study are presented here, as the results of the economic assessment have been published previously. Inverse probability of treatment weighting (IPTW) using the propensity score analysis was undertaken in an effort to adjust for potential bias due to non-randomization. Loco-regional control, specific and overall survival assessed 18 months after treatment were evaluated, as well as long-term toxicity and salivary function. Results : The analysis included 166 patients. The following results are given after IPTW adjustment. Loco-regional control rate at 18 months was significantly better in the Tomotherapy® group: 83.3% (95% CI: [72.5%; 90.2%]) vs 72.7% (95% CI: [62.1%; 80.8%]) in the RapidArc® group (p=0.025). Cancer specific survival rate was better in the Tomotherapy® group: 97.2% (95% CI: [89.3%; 99.3%]) vs 85.5% (95% CI: [75.8%; 91.5%]) in the RapidArc® group (p=0.014). No significant difference was shown on progression-free or overall survival. Tomotherapy® induced fewer acute salivary disorders (p=0.012). Post-treatment salivary function degradation was worse in the RapidArc® group (p=0.012). Conclusion : Tomotherapy® provided better loco-regional control and cancer specific survival than RapidArc®, with fewer salivary disorders. No significant difference was shown on progression-free and overall survival. These results should be explored in a randomized trial.