Combining tumor response and personalized risk assessment: Potential for adaptation of concurrent chemotherapy in locoregionally advanced nasopharyngeal carcinoma in the intensity-modulated radiotherapy era

Luo, Wei-Jie; Zou, Wen-Qing; Liang, Shuli; Chen, Lei; Zhou, Guan-Qun; Peng, Hao; Li, Wenfei; Xu, Lan; Sun, Ying; Lin, Aihua; Ma, Jun; Mao, Yan‐Ping

doi:10.1016/j.radonc.2020.10.005

Cited by 16 publications

(25 citation statements)

References 37 publications

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“…Accordingly, radiotherapy is an important means of anticancer therapy for NPC. Recent studies have shown that the 5-year survival rate of NPC patients ranges from 77.2% to 89.7%, with radiotherapy as the cornerstone of comprehensive treatment (4)(5)(6). However, because many important organs at risk (OARs) are adjacent to the nasopharynx, it is difficult to further improve local control of the tumor by increasing the radiation dose.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Dosimetric Benefits of Three Precise Radiotherapy Techniques in Nasopharyngeal Carcinoma Patients Using a Priority-Classified Plan Optimization Model

et al. 2021

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IntroductionAlthough intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT) and tomotherapy (TOMO) are broadly applied for nasopharyngeal carcinoma (NPC), the best technique remains unclear. Therefore, this study was conducted to address this issue.MethodsThe priority-classified plan optimization model was applied to IMRT, VMAT and TOMO plans in forty NPC patients according to the latest international guidelines. And the dosimetric parameters of planning target volumes (PTVs) and organs at risk (OARs) were compared among these three techniques. The Friedman M test in SPSS software was applied to assess significant differences.ResultsThe median PGTVnx coverage of IMRT was the lowest (93.5%, P < 0.001) for all T categories. VMAT was comparable to TOMO in OARs clarified as priority I and II, and both satisfied the prescribed requirement. IMRT resulted in a relatively high dose for V25 and V30. Interestingly, subgroup analysis showed that the median PTV coverage of the three techniques was no less than 95% in the early T stage. The heterogeneity index (HI) of PGTVnx in VMAT was better than that in IMRT (P = 0.028). Compared to TOMO, VMAT showed a strong ability to protect eyesight and decrease low-dose radiation volumes. In the advanced T stage subgroup, TOMO numerically achieved the highest median PGTVnx coverage volume compared with VMAT and IMRT (93.61%, 91% and 90%, respectively). The best CI and HI of PCTV-1 were observed in TOMO. Furthermore, TOMO was better than VMAT for sparing the brain stem, spinal cord and temporal lobes (all P < 0.05). However, the median V5, V10, V15, V20 and V25 were significantly higher with TOMO than with VMAT (all P < 0.05).ConclusionIn the early T stage, VMAT provides a similar dose coverage and protection of OARs to IMRT, and there are no obvious advantages to choosing TOMO for NPC patients in the early T stage. TOMO may be recommended for patients in the advanced T stage due as it provides the largest dose coverage of PGTVnx and the best protection of the brain stem, spinal cord and temporal lobes. Additionally, more randomized clinical trials are needed for further clarification.

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Section: Introductionmentioning

confidence: 99%

Comparison of Dosimetric Benefits of Three Precise Radiotherapy Techniques in Nasopharyngeal Carcinoma Patients Using a Priority-Classified Plan Optimization Model

et al. 2021

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“…However, not all patients showed significant tumor regression after IC. Data from multiple retrospective studies indicated that a considerable number of patients have poor sensitivity to IC 20,21,26 . According to statistics, 31.7% of the patients in this study were identified as “nonresponder” (SD/PD).…”

Section: Discussionmentioning

confidence: 74%

“…In addition, administering IC prior to radiotherapy represents a unique opportunity to evaluate tumor chemotherapeutic sensitivity, which may guide subsequent individualized treatment. Recent studies have suggested that tumor response to IC is a strong indicator of survival in NPC 19–23 . Given the above variables affect patient survival outcomes in different degrees, it seems reasonable to develop a convenient and precise model to evaluate patients and treat them with tailored strategies.…”

Section: Introductionmentioning

confidence: 99%

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A nomogram based on tumor response to induction chemotherapy may predict survival in locoregionally advanced nasopharyngeal carcinoma

et al. 2022

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Background: To evaluate the clinical significance of tumor response to induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LANPC) patients and further to develop a nomogram for predicting survival prognosis. Methods: A total of 498 patients with stage III-IVA NPC applying IC and concurrent chemotherapy were reviewed (training cohort, n = 376; validation cohort, n = 122). Results: Tumor response was an independent predictor for clinical outcomes. The nomogram included age, N stage, pretreatment Epstein-Barr virus DNA, lymphocyte-to-monocyte ratio, and tumor response achieved an ideal C-index of 0.703 (95% CI 0.655-0.751) in the validation cohort for predicting overall survival (OS), which outperformed than that of the TNM system alone (Cindex, 0.670, 95% CI: 0.622-0.718). In addition, the nomogram could successfully classified patients into different risk groups. Conclusions: We established and validated a precise and convenient nomogram based on tumor response for predicting the OS of LANPC patients.

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“…Moreover, IC+CCRT was proposed as level 2A evidence for these patients by the National Comprehensive Cancer Network (NCCN) guidelines, and it has become the rst-line therapy for LANPC [6]. Nevertheless, approximately 20-30% of NPC patients report unsatisfactory e cacy after IC+CCRT [7,8], and local recurrence and distant metastasis are still the main reasons for treatment failure in LANPC patients [9]. The application of IC+CCRT for ineffective NPC patients will signi cantly increase the toxicity and treatment cost [10].…”

Section: Introductionmentioning

confidence: 99%

MRI-Based Random Survival Forest Model Improves the Prediction of Progression-Free Survival to Induction Chemotherapy plus Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

Pei

Wang

Liao

et al. 2022

Preprint

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BackgroundThe present study aimed to explore the application value of random survival forest (RSF) model and Cox model in predicting the progression-free survival (PFS) among patients with locoregionally advanced nasopharyngeal carcinoma (LANPC) after induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT).MethodsEligible LANPC patients underwent magnetic resonance imaging (MRI) scan before treatment were subjected to radiomics feature extraction. Radiomics and clinical features of patients in the training cohort were subjected to RSF analysis to predict PFS and were tested in the testing cohort. The performance of an RSF model with clinical and radiologic predictors was assessed with the area under the receiver operating characteristic (ROC) curve (AUC) and Delong test and compared with Cox models based on clinical and radiologic parameters. Further, the Kaplan-Meier method was used for risk stratification of patients.ResultsA total of 294 LANPC patients (206 in the training cohort; 88 in the testing cohort) were enrolled and underwent magnetic resonance imaging (MRI) scans before treatment. The AUC value of the clinical Cox model, radiomics Cox model, clinical + radiomics Cox model, and clinical + radiomics RSF model in predicting 3- and 5-year PFS for LANPC patients was [0.545 vs 0.648 vs 0.648 vs 0.899 (training cohort), and 0.566 vs 0.736 vs 0.73 vs 0.861 (testing cohort); 0.556 vs 0.604 vs 0.611 vs 0.897 (training cohort), and 0.591 vs 0.661 vs 0.676 vs 0.847 (testing cohort), respectively]. Delong test showed that the RSF model and the other three Cox models were statistically significant, and the RSF model markedly improved prediction performance (P<0.001). Additionally, the PFS of the high-risk group was lower than that of the low-risk group in the RSF model (P<0.001), while comparable in the Cox model (P>0.05).ConclusionThe RSF model may be a potential tool for prognostic prediction and risk stratification of LANPC patients.

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Combining tumor response and personalized risk assessment: Potential for adaptation of concurrent chemotherapy in locoregionally advanced nasopharyngeal carcinoma in the intensity-modulated radiotherapy era

Cited by 16 publications

References 37 publications

Comparison of Dosimetric Benefits of Three Precise Radiotherapy Techniques in Nasopharyngeal Carcinoma Patients Using a Priority-Classified Plan Optimization Model

Comparison of Dosimetric Benefits of Three Precise Radiotherapy Techniques in Nasopharyngeal Carcinoma Patients Using a Priority-Classified Plan Optimization Model

A nomogram based on tumor response to induction chemotherapy may predict survival in locoregionally advanced nasopharyngeal carcinoma

MRI-Based Random Survival Forest Model Improves the Prediction of Progression-Free Survival to Induction Chemotherapy plus Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

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