Chemo-radiotherapy in patients with locally advanced nasopharyngeal carcinoma: a radiation therapy oncology group study.

Al‐Sarraf, Muhyi; Pajak, T F; Cooper, Jay S.; Mohiuddin, Majid; Herskovic, Arnold; Ager, Phyllis J.

doi:10.1200/jco.1990.8.8.1342

Cited by 143 publications

(55 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Use of combined radiation therapy and chemotherapy has significantly improved local control and disease-free survival for patients with high-staged NPC [10,11]. Because of its success, long-term quality of life issues become important.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with NPC are typically treated with radiation therapy rather than surgery because of the anatomically challenging/ difficult location and a demonstrated favorable response to irradiation and chemotherapy [9][10][11]. Because of the proximity to surrounding critical structures, NPC is an ideal disease site to evaluate implementation of IMRT.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Cheng

Chao

Low

2001

Intl Journal of Cancer

125

View full text Add to dashboard Cite

SUMMARY We studied target volume coverage and normal tissue sparing of serial tomotherapy intensity modulated radiation therapy (IMRT) and fixed-field IMRT for nasopharyngeal carcinoma (NPC), as compared with those of conventional beam arrangements. Twelve patients with NPC (T2-4N1-3M0) at Mallinckrodt Institute of Radiology underwent computed tomography simulation. Images were then transferred to a virtual simulation workstation computer for target contouring. Target gross tumor volumes (GTV) were primary nasopharyngeal tumor (GTV NP ) with a prescription of 70 Gy, grossly enlarged cervical nodes (GTV LN ) with a prescription of 70 Gy, and the uninvolved cervical lymphatics [designated as the clinical tumor volume (CTV)] with a prescription of 60 Gy. Critical organs, including the parotid gland, spinal cord, brain stem, mandible, and pituitary gland, were also delineated. Conventional beam arrangements were designed following the guidelines of Intergroup (SWOG, RTOG, ECOG) NPC Study 0099 in which the dose was prescribed to the central axis and the target volumes were aimed to receive the prescribed dose ± 10%. Similar dosimetric criteria were used to assess the target volume coverage capability of IMRT. Serial tomotherapy IMRT was planned using a 0.86-cm wide multivane collimator, while a dynamic multileaf collimator system with five equally spaced fixed gantry angles was designated for fixed-beam IMRT. The fractional volume of each critical organ that received a certain predefined threshold dose was obtained from dose-volume histograms of each organ in either the three-dimensional or IMRT treatment planning computer systems. Statistical analysis (paired t-test) was used to examine statistical significance. We found that serial tomotherapy achieved similar target volume coverage as conventional techniques (97.8 ± 2.3% vs. 98.9 ± 1.3%). The static-field IMRT technique (five equally spaced fields) was inferior, with 92.1 ± 8.6% fractional GTV NP receiving 70 Gy ± 10% dose (P < 0.05). However, GTV LN coverage of 70 Gy was significantly better with both IMRT techniques (96.1 ± 3.2%, 87.7 ± 10.6%, and 42.2 ± 21% for tomotherapy, fixed-field IMRT, and conventional therapy, respectively). CTV coverage of 60 Gy was also significantly better with the IMRT techniques. Parotid gland sparing was quantified by evaluating the fractional volume of parotid gland receiving more than 30 Gy; 66.6 ± 15%, 48.3 ± 4%, and 93 ± 10% of the parotid volume received more than 30 Gy using tomotherapy, fixed-field IMRT, and conventional therapy, respectively (P < 0.05). Fixed-field IMRT technique had the best parotid-sparing effect despite less desirable target coverage. The pituitary gland, mandible, spinal cord, and brain stem were also better spared by both IMRT techniques. These encouraging dosimetric results substantiate the theoretical advantage of inverse-planning IMRT in the management of Publication of the International Union Against Cancer NPC. We showed that target coverage of the primary tumor was maintained and nodal coverage ...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Cheng

Chao

Low

2001

Intl Journal of Cancer

125

View full text Add to dashboard Cite

show abstract

“…Thus far, the only available published data regarding treatment outcome in Malaysia was from a study on 285 patients treated from [2001][2002][2003][2004][2005] at Penang General Hospital where the 5 years overall survival (OS) was only 33.3% (Phua et al, 2011). Reported 5 year OS rates worldwide ranged from 32% to 62% based on more than 9500 patients with all stages of NPC but these were results from older series (ShuChen, 1980;Hsu et al, 1982;Al-Sarraf et al, 1990;Lee et al, 1992;1993;Qin et al, 1998;Wang et al, 1998;Ali et al, 1999;Lin et al, 1999, Terence et al, 2003. The University of California-San Francisco reported a study involving 67 patients who underwent IntensityModulated Radiotherapy (IMRT) treatment for NPC (70% stage III and IV) and showed a 4 years OS of 88% (Lee , Ngie Min Ung 1 et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcome for Nasopharyngeal Carcinoma in University Malaya Medical Centre from 2004-2008

Phua

Loo²,

Yusof³

et al. 2013

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Background: Nasopharyngeal carcinoma (NPC) is the commonest radiocurable cancer in Malaysia. This study aimed to determine the treatment outcomes and late effects of radiotherapy for NPC patients treated in University Malaya Medical Centre (UMMC). Materials and Methods: All newly diagnosed patients with NPC referred for treatment to the Oncology unit at UMMC from 2004-2008 were retrospectively analyzed. Treatment outcomes were 5 years overall survival (OS), disease free survival (DFS), cause-specific survival (CSS), locoregional control (LRC) and radiotherapy-related late effects. The Kaplan-Meier method was used for survival analysis and differences in survival according to AJCC stage was compared using the log-rank test. Results: A total of 176 patients with newly diagnosed NPC were treated in UMMC during this period. Late presentation was common, with 33.5% presenting with T3-4 disease, 84.7% with N1-3 disease and 75.6% with AJCC stage 3-4 disease. Radical RT was given to 162 patients with 22.7% having RT alone and 69.3% having CCRT. The stipulated OTT was 7 weeks and 72.2% managed to complete their RT within this time period. Neoadjuvant chemotherapy was given to 14.8% while adjuvant chemotherapy was administered to 16.5%. The 5 years OS was 51.6% with a median follow up of 58 months. The 5 years OS according to stage were 81.8% for stage I, 77.9% for stage II, 47.4% for stage III and 25.9% for stage IV. The 5 years overall CSS, DFS and LRC were 54.4%, 48.4% and 70.6%, respectively. RT related late effects were documented in 80.2%. The commonest was xerostomia (66.7%). Other documented late effects were hearing deficit (17.3%), visual deficit (3.1%), neck stiffness (3.1%) , dysphagia (3.4%), cranial nerve palsy (2.5%), pneumonitis (0.6%) and hypothyroidism (1.2%). Conclusions: The 5 years OS and LRC in this study are low compared to the latest studies especially those utilizing IMRT. Implementation of IMRT for NPC treatment should be strongly encouraged.

show abstract

“…Interruptions in RT causing a prolonged treatment time have been reported to be detrimental for local control and survival in NPC [15][16][17][18] . The number of patients having neo-adjuvant or adjuvant chemotherapy was low in this study at 13.5% and 17% respectively but meta-analyses [18] have shown no survival benefit, therefore it is arguable whether this played a contributory role. For the time being, there is no known effective adjuvant treatment that has been shown to improve survival [20] .…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of treatment results for nasopharyngeal carcinoma in Philippine Oncology Centre Corporation from 2002-2009

Chong

Arnold

Mario

2015

J Nasopharyng Carcinoma

View full text Add to dashboard Cite

Objective:This study aimed to determine the treatment outcomes and late effects of radiotherapy for NPC patients treated in Philippine Oncology Centre Corporation (POCC). Materials and Methods: The patients with NPC referred for treatment at POCC from 2002-2009 were retrospectively analyzed. Treatment outcomes were 5 years overall survival (OS), disease free survival (DFS), cause-specific survival (CSS), loco-regional control (LRC) and radiotherapy-related late effects. The Kaplan-Meier method was used for survival analysis and differences in survival according to AJCC stage was compared using the log-rank test. Results: A total of 106 patients with newly diagnosed NPC were treated in POCC during this period. Late presentation was common, with 19.8% presenting with T3-4 disease, 88.7% with N1-3 disease and 73.5% with AJCC stage 3-4 disease. Radical RT was given to 96 patients with 23.6% having RT alone and 67.4% having CCRT. The stipulated OTT was 7 weeks and 72% managed to complete their RT within this time period. Neoadjuvant chemotherapy was given to 13.5% while adjuvant chemotherapy was administered to 17%. The 5 years OS was 51.5% with a median follow up of 56 months. The 5 years OS according to stage were 81.8% for stage I, 77.9% for stage II, 47.4% for stage III and 25.9% for stage IV. The 5 years overall CSS, DFS and LRC were 54.4%, 48.4% and 70.9%, respectively. RT related late effects were documented in 71.7%. The commonest was xerostomia (66.7%). Other documented late effects were hearing deficit (18.2%), visual deficit (4.2%), neck stiffness (4.2%), dysphagia (2.3%), cranial nerve palsy (2.4%), pneumonitis (0.9%) and hypothyroidism (1.3%). Conclusions: The 5 years OS and LRC in this study are low compared to the latest studies especially those utilizing IMRT. Implementation of IMRT for NPC treatment should be strongly encouraged.

show abstract

Chemo-radiotherapy in patients with locally advanced nasopharyngeal carcinoma: a radiation therapy oncology group study.

Cited by 143 publications

References 20 publications

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Treatment Outcome for Nasopharyngeal Carcinoma in University Malaya Medical Centre from 2004-2008

Retrospective analysis of treatment results for nasopharyngeal carcinoma in Philippine Oncology Centre Corporation from 2002-2009

Contact Info

Product

Resources

About