Simultaneous Integrated Boost (SIB)- IMRT

Loco-regional failures remain a major concern following irradiation of locally advanced head and neck cancers. This has led radiation oncologists to investigate novel approaches offering better therapeutic indexes. Modification of dose fractionation schedules can improve the therapeutic outcome by using accelerated or hyperfractionated regimes -Ang, 1990; Ang, 1998; Fu, 2000; Gwozdz, 1997-. Intensity Modulated Radiation Therapy (IMRT) technique allows the planning and irradiation of different targets at different dose levels in a single treatment session, instead of successive treatment plans. With conventional 2D radiotherapy, both normal tissues and tumors are irradiated with a similar dose per fraction of 1.8-2 Gy, whereas with IMRT dose gradients are introduced in such a manner that normal tissues receive a much lower dose per fraction.

Inclusion criteria

• Patients older than 18 years
• Patients with squamous cell carcinoma of the oropharynx, hypopharynx and larynx
• Stage T2-N0-M0, T2-N1-M0 or T3-N0-M0
• World Health Organization (WHO) Performance Status of 0 or 1 or Karnofsky performance status ≥ 70.
• Provision of written informed consent

Exclusion criteria

• Second primary tumor at the time of diagnosis
• Previous history of malignant tumor in the last five years except basal cell carcinoma and carcinoma in situ of the cervix
• Previous treatment with surgery, radiotherapy or chemotherapy for head and neck malignancy
• Any evidence of severe or uncontrolled systemic diseases (e.g., unstable or uncompensated respiratory, cardiac, hepatic or renal disease), or psychological disorder
• Pregnant or lactating women