Individualized clinical target volume delineation and efficacy analysis in unilateral nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT): 10-year summary

Xie, Donglai; Zheng, Wei; Li, Wang‐Zhong; Cheng, Wanqin; Tao, Yijing; Wang, Lei; Lv, Shaowen; Lin, Feifei; Cui, Nian Ji; Zhao, Chong; Ma, Jun; Huang, Shaomin; Lu, Tai‐Xiang; Han, Yaqian; Su, Yong

doi:10.1007/s00432-022-03974-7

Cited by 7 publications

(11 citation statements)

References 24 publications

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“…Li et al [ 22 ] and Sanford et al [ 19 ] adopted different individualized delineations based on T classification and spread patterns, both attained excellent long-termed local control and low late toxicities. Xie et al [ 23 ] reported individualized CTV delineation in unilateral NPC yielded excellent long-term local control with limited out-of-field recurrences. In this cohort, unilateral NPC was defined as a nasopharyngeal mass confined to one side of the nasopharynx and did not exceed the midline [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Unraveling the patterns and pathways of local recurrence of nasopharyngeal carcinoma: evidence for individualized clinical target volume delineation

Yan

Huang

et al. 2023

Radiat Oncol

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Backgrounds Despite publication of international guidelines, there are notable controversial points of clinical target volume (CTV) delineation in nasopharyngeal carcinoma (NPC). Recently, scholars proposed a novel way of delineation of CTV in NPC—individualization of CTV delineation based on T classification and spread patterns, which yielded excellent long-term local control with limited late toxicities. The aim of this study was to clarify the anatomic patterns and pathways of local recurrence of NPC and provide a clinical reference for the delineation of CTV. Methods A total of 869 patients with non-metastatic NPC were treated with intensity-modulated radiation therapy (IMRT) at our institution between 2009 and 2010. Among the 57 cases of local/locoregional recurrence, 52 cases with traceable radiotherapy plans and magnetic resonance imaging at the time of the first diagnosis of recurrence were included. Anatomical structures and gross tumor volume of local recurrence were contoured. The incidence of relapse of each anatomic structure, route of local recurrence, and their correlation were analyzed. Results Locally advanced disease had a significantly increased risk of recurrence in the posterior nasal cavity and a trend towards higher risk of recurrence in the clivus, lateral pterygoid muscle, and hypoglossal canal. Based on the incidence of local recurrence, we constructed a high-risk map for the early and locally advanced stages. Local recurrences were classified into five routes, where anterior extension accounted for the majority (30.8%), and caudal tumor extension pathway had the lowest incidence (5.8%). There was a significant correlation between the local recurrences of neural foramina and neighboring anatomical structures along each pathway. All cases relapsed at unilateral cavernous sinus, most at the same side of primary tumor. Based on our findings, we proposed some suggestions on delineations of CTV, based on T classification and local extension pattern. Conclusions Local recurrence of NPC varied according to T classification, followed a stepwise pattern, spread via neural foramina, and recurred at ipsilateral cavernous sinus. This provides meaningful clinical evidence for delineation of CTV, especially individualized delineation.

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Section: Discussionmentioning

confidence: 99%

Unraveling the patterns and pathways of local recurrence of nasopharyngeal carcinoma: evidence for individualized clinical target volume delineation

Yan

Huang

et al. 2023

Radiat Oncol

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“…Li et al [22] and Sanford et al [19] adopted different individualized delineation based on T classi cation and spread patterns, both attained excellent long-termed local control and low late toxicities. Xie et al [23] reported individualized CTV delineation in unilateral NPC yielded excellent long-term local control with limited out-of-eld recurrences. In this cohort, unilateral NPC was de ned as a nasopharyngeal mass con ned to one side of the nasopharynx and did not exceed the midline [23] .…”

Section: Discussionmentioning

confidence: 99%

“…Xie et al [23] reported individualized CTV delineation in unilateral NPC yielded excellent long-term local control with limited out-of-eld recurrences. In this cohort, unilateral NPC was de ned as a nasopharyngeal mass con ned to one side of the nasopharynx and did not exceed the midline [23] . The CTVs were determined based on the distance from the gross tumor, and the contralateral para-pharyngeal space and skull base ori ces were spared from irradiation [23] .…”

Section: Discussionmentioning

confidence: 99%

“…In this cohort, unilateral NPC was de ned as a nasopharyngeal mass con ned to one side of the nasopharynx and did not exceed the midline [23] . The CTVs were determined based on the distance from the gross tumor, and the contralateral para-pharyngeal space and skull base ori ces were spared from irradiation [23] . Our study proved that local recurrence diffed among various primary T classi cation, followed a stepwise pattern, and shared similar routes with primary invasion, which supported the rationale of individualization of CTV delineation based on T classi cation and spread patterns.…”

Section: Discussionmentioning

confidence: 99%

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Unraveling the Patterns and Pathways of Local Recurrence of Nasopharyngeal Carcinoma: Evidence for Individualized Clinical Target Volume Delineation

Yan

Huang

et al. 2022

Preprint

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Backgrounds: Despite publication of international guidelines, there are notable controversial points of clinical target volume (CTV) delineation in nasopharyngeal carcinoma (NPC). Recently, scholars proposed a novel way of delineation of CTV in NPC -- individualization of CTV delineation based on T classification and spread patterns, which yielded excellent long-term local control with limited late toxicities. The aim of this study was to clarify the anatomic patterns and pathways of local recurrence of NPC and provide a clinical reference for the delineation of CTV. Methods: A total of 869 patients with non-metastatic NPC were treated with intensity-modulated radiation therapy (IMRT) at our institution between 2009 and 2010. Among the 57 cases of local/locoregional recurrence, 52 cases with traceable radiotherapy plans and magnetic resonance imaging at the time of the first diagnosis of recurrence were included. Anatomical structures and gross tumor volume of local recurrence were contoured. The incidence of relapse of each anatomic structure, route of local recurrence, and their correlation were analyzed. Results: Locally advanced disease had a significantly increased risk of recurrence in the posterior nasal cavityand a trend towards higher risk of recurrence in the clivus, lateral pterygoid muscle, and hypoglossal canal. Based on the incidence of local recurrence, we constructed a high-risk map for the early and locally advanced stages. Given the higher incidence of relapses in locally advanced disease, these structures were strongly recommended to be encompassed by the CTV of T3-4 diseases, including posterior ethmoid sinus, lateral pterygoid muscle, hypoglossal canal, inferior orbital fissure, and cavernous sinus. Local recurrences were classified into five routes, where anterior extension accounted for the majority (30.8%), and caudal tumor extension pathway had the lowest incidence (5.8%). There was a significant correlation between the local recurrences of neural foramina and neighboring anatomical structures along each pathway. All cases relapsed at unilateral cavernous sinus, most at the same side of primary tumor. Conclusions: Local recurrence of NPC varied according to T classification, followed a stepwise pattern, spread via neural foramina, and recurred at ipsilateral cavernous sinus. This provides meaningful clinical evidence for delineation of CTV, especially individualized delineation.

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“…In a retrospective report of 95 unilateral NPC, unilateral irradiation was delivered by delineating CTV2 as a 15–20 mm volumetric expansion from GTV with deliberate exclusion of contralateral nasopharyngeal mucosa and parapharyngeal space and skull base structures [ 11 ]. This contouring approach has led to an excellent 10-year local recurrence-free survival rate of 96.2%, in which no out-field recurrence occurred contralaterally.…”

Section: Target Delineationmentioning

confidence: 99%

Current Radiotherapy Considerations for Nasopharyngeal Carcinoma

Chow

Beitler³

et al. 2022

Cancers

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Radiotherapy is the primary treatment modality for nasopharyngeal carcinoma (NPC). Successful curative treatment requires optimal radiotherapy planning and precise beam delivery that maximizes locoregional control while minimizing treatment-related side effects. In this article, we highlight considerations in target delineation, radiation dose, and the adoption of technological advances with the aim of optimizing the benefits of radiotherapy in NPC patients.

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Individualized clinical target volume delineation and efficacy analysis in unilateral nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT): 10-year summary

Cited by 7 publications

References 24 publications

Unraveling the patterns and pathways of local recurrence of nasopharyngeal carcinoma: evidence for individualized clinical target volume delineation

Unraveling the patterns and pathways of local recurrence of nasopharyngeal carcinoma: evidence for individualized clinical target volume delineation

Unraveling the Patterns and Pathways of Local Recurrence of Nasopharyngeal Carcinoma: Evidence for Individualized Clinical Target Volume Delineation

Current Radiotherapy Considerations for Nasopharyngeal Carcinoma

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