Long‐term outcomes in patients with nasopharyngeal carcinoma treated with reduced‐volume conformal radiotherapy: A retrospective cohort study

Billan, Salem; Bakouche, V.; Borzov, E.; Gil, Ziv; Abdah-Bortnyak, Roxolyana

doi:10.1111/1754-9485.12722

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…The CTV volume in Lin's study (CTV54) was 160.2 cc (range, 86.5-337.1), which was significantly smaller than the one in Sultanem's study from UCSF (average 212 cc, range, 104-339). Groups from nonendemic areas also reported their results with reduced CTV volumes (17)(18)(19).…”

Section: Discussionmentioning

confidence: 83%

Variations of Clinical Target Volume Delineation for Primary Site of Nasopharyngeal Cancer Among Five Centers in China

Zhang

Yang

et al. 2020

Front. Oncol.

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The purpose of this study is to investigate the current status of clinical target volume (CTV) delineation for primary site of nasopharyngeal cancer (NPC) among five large tertiary cancer centers in China. Materials and Methods: The simulation CT and MR images of a patient with T3N2M0 NPC were sent to the centers participating. Fourteen experienced physicians contoured the targets independently, and the outlined structures were compared. The consistency and differences among these 14 CTVs are discussed. Results: Two different CTV designs were used in the centers. "One-CTV" design defines one CTV with a dose of 60 Gy, whereas "two-CTV" design has a high-risk CTV with dose of 60 Gy and a medium risk CTV with dose of 54 Gy. We found that the coverage of prophylactic area is very consistent between these two designs. The variances on the coverage of some sites were also significant among physicians, including covering cavernous sinus at un-involved side, posterior space of styloid process, and caudal border on posterior pharyngeal wall. Conclusions: Standardization is the main requirement for personalization of care; our study shows that among the 14 physicians in the five centers the coverage of prophylactic areas is in excellent agreement. Two distinct strategies on CTV design are currently being used, and multiple controversies were found, suggesting further optimization of CTV for primary site of NPC is needed.

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Section: Discussionmentioning

confidence: 83%

Variations of Clinical Target Volume Delineation for Primary Site of Nasopharyngeal Cancer Among Five Centers in China

Zhang

Yang

et al. 2020

Front. Oncol.

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“…Sanford and colleagues [17] designed individual delineations of the CTV for 73 NPC patients treated with IMRT; they found that the 5-year local control, regional control, and OS rates were 94%, 99%, and 84%, respectively. The reduced-volume protocol designed by Billan et al [33] decreased the volumes of PTV of primary tumor (PTV-P) by 27.6% compared to those in RTOG 0615, and the 3-year disease-free survival was 75%. Given the present situation, international guidelines introduced the principle of the "5 + 5 mm expansion" margin from the GTV (Table 4) [27].…”

Section: Discussionmentioning

confidence: 99%

“…If we include all the high-risk regions and the extension expands uniformly from the GTV, normal tissues are exposed to excessively high doses of radiation. To decrease the doses to normal tissues, reduced target volumes were applied for NPC 15 - 17 , 33 . Lin and colleagues 15 , 16 used reduced target volumes in IMRT for NPC, and their protocol provided promising local control and survival with acceptable adverse events.…”

Section: Discussionmentioning

confidence: 99%

Different Risk Target Volumes for Nasopharyngeal Carcinoma Treated with Simultaneous Integrated Boost Intensity-Modulated Radiotherapy

et al. 2020

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Background and Objectives: Although intensity-modulated radiotherapy (IMRT) provides promising survival advantages and fewer late complications in patients with nasopharyngeal cancer (NPC), appropriated target volumes and prescribed doses are still being explored. This study aimed to propose different risk target volumes and corresponding prescribed doses in our center and to evaluate the physical basis and efficacy of this protocol based on the long-term survival of NPC patients. Methods and Materials: We retrospectively assessed patients with histology-proven non-metastatic NPC treated with definitive IMRT using our protocol of different risk target volumes and corresponding prescribed doses based on the orderly stepwise pattern of tumor spread. We described the delineation for different risk target volumes and the design of IMRT planning for an NPC case. Additionally, we compared the dosimetric distributions between the China protocol and our protocol through two NPC cases. The patterns of failure and locoregional control were the primary endpoints. All survival outcomes were calculated using the Kaplan-Meier method. Results: From January 2013 to December 2014, a total of 335 patients were treated; the median follow-up for patients who survived was 70 months. All patients completed IMRT using our protocol. Twenty-five patients developed locoregional recurrence, and all recurrences occurred within the high-dose target volumes. The rates of locoregional recurrence-free survival, distant metastasis-free survival, progression-free survival, and overall survival at 5 years were 92.2%, 92.1%, 85.9%, and 86.3%, respectively. The biological effective doses of the prescribed doses in our protocol were similar to those of the China and 0615 protocols. Moreover, our protocol offered a reduction in D1 and D2 in the primary gross tumor volume (GTV), while V30 and V40 in normal tissues were lower. Conclusion: Our protocol of different risk target volume delineations and corresponding prescribed doses based on the stepwise pattern of tumor spread resulted in favorable locoregional control with no relapse outside the GTV.

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Precision medicine in head and neck cancer

Kaidar‐Person

Gil

Billan

2018

Drug Resistance Updates

142

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Long‐term outcomes in patients with nasopharyngeal carcinoma treated with reduced‐volume conformal radiotherapy: A retrospective cohort study

Abstract: A reduced volume approach for radiotherapy in primary NPC provided acceptable long-term local control.

Cited by 3 publications

References 27 publications

Variations of Clinical Target Volume Delineation for Primary Site of Nasopharyngeal Cancer Among Five Centers in China

Variations of Clinical Target Volume Delineation for Primary Site of Nasopharyngeal Cancer Among Five Centers in China

Different Risk Target Volumes for Nasopharyngeal Carcinoma Treated with Simultaneous Integrated Boost Intensity-Modulated Radiotherapy

Precision medicine in head and neck cancer

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