Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy

Xue, Fengxia; Hu, Chengfang; He, Xianghuo

doi:10.7150/jca.17858

Cited by 23 publications

(25 citation statements)

References 30 publications

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“…For all patients, the estimated 5-year OS, LRFS, DMFS and DFS rates were 87.5%, 94.1%, 87.0%, and 81.5%, respectively. The survival of our cohort was relatively better than those in other studies of 5-year overall survival rate varying from 83.9 to 87.4% in all-stages NPC patients treated with IMRT [ 19 , 29 – 31 ]. The relatively short follow-up time (median: 58 months) in our study may lead to the higher survival rate.…”

Section: Discussioncontrasting

confidence: 65%

A retrospective study of 606 cases of nasopharyngeal carcinoma with or without oropharyngeal candidiasis during radiotherapy

Qiu

Xia

et al. 2017

PLoS ONE

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BackgroundTo evaluate the clinical characteristics, treatment-related toxicities and survival in patients with nasopharyngeal carcinoma (NPC) with or without oropharyngealcandidiasis (OPC) during radiotherapy.MethodsThe current study was conducted with NPC patients undergoing radiotherapy at Sun Yat-Sen University Cancer Center between June 2011 and May 2012. A clinical diagnosis of candidiasis was determined on the basis of a positive potassium hydroxide (KOH) test and the presence of pseudomembranous (white) form of candidal overgrowth. The Cox proportional hazard regression model was used to test the association of OPC and related survival rates.ResultsCompared with the non-OPC group, the OPC group had significantly increased occurrence rates of grade 3–4 mucositis (14.5% vs. 7.4%, P = 0.049), anaemia (11.3% vs. 4.4%, P = 0.020), hepatotoxicity (4.8% vs. 1.1%, P = 0.021) and critical weight loss (85.5% vs. 56.6%, P<0.001) during radiotherapy. The OPC group had a significantly lower disease-free survival (DFS) (70.9% vs. 82.6%, P = 0.012), mainly as a result of a reduction in locoregional relapse-free survival (LRFS) (87.0%vs. 94.9%, P = 0.025). After stratification by T stage, the 5-year DFS in T3-4 patients were 82.0% and 68.8% in non-OPC and OPC groups, respectively (P = 0.022). Multivariate analyses indicated that OPC was a prognostic factor for LRFS and DFS.ConclusionsOPC during radiotherapy may worsen the nutritional status of NPC patients according to weight loss and anaemia, leading to a negative impact on 5-year locoregional relapse-free survival and disease-specific survival. Further investigations are needed to explore whether prevention and treatment of OPC during radiotherapy will be useful.

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Section: Discussioncontrasting

confidence: 65%

A retrospective study of 606 cases of nasopharyngeal carcinoma with or without oropharyngeal candidiasis during radiotherapy

Qiu

Xia

et al. 2017

PLoS ONE

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“…The T and N stages are associated with LRFS and DMFS, as demonstrated by previous research. [ 28 , 29 ] Xu et al demonstrated that IC plus CCRT has no significant survival benefit for patients with locoregionally advanced NPC but results in significant metastasis-free survival efficacy in T3 to 4/N0 to 1 populations. [ 30 ] However, more and more hard evidence has confirmed that a combination of IC and CCRT is a promising treatment strategy for NPC.…”

Section: Discussionmentioning

confidence: 99%

Analysis of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma

Wu¹,

Quan²,

Han

et al. 2020

Medicine

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The present study aimed to retrospectively analyze the survival outcomes and prognostic factors for patients with nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT). Clinical data was collected from 691 patients with NPC receiving IMRT from January 2009 to August 2015. A survival analysis was performed and prognostic factors were analyzed using the Kaplan–Meier method, the Cox proportional hazards regression model, and the log-rank test. The median follow-up time was 62.8 months. Sixty-three patients experienced relapse, 44 cases (70%) of which occurred within 3 years. Six cases (9.5%) remained in remission for over 5 years. Seventy-two patients developed metastasis, 63 cases (87.5%) of which occurred within 3 years and only 1 case occurred after 5 years (1.3%). Five-year disease special survival (DSS), progression free survival, locoregional recurrence free survival, and distant metastasis free survival were 86.5%, 82.5%, 90.7%, and 89.4%, respectively in patients with NPC. Patients with stage III NPC with and without induction chemotherapy had 5-year DSS rates of 95.8% and 89.3%, respectively ( P = .00). Patients with stage IVa NPC with and without induction chemotherapy had 5-year DSS rates of 73.1% and 68.9%, respectively ( P = .04). The 5-year DSS rates of patients with stage III with or without concurrent chemotherapy were 92.8% and 85.5%, respectively ( P = .04). The 5-year DSS rates of patients with stage IV with or without concurrent chemotherapy were 72.7% and 53.0% ( P = .02). IMRT improves the survival rate of patients with NPC. Recurrence and metastasis mainly occur within 2 to 3 years after radiotherapy. Induction and concurrent chemotherapy improve the 5-year DSS of patients with locally advanced NPC.

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“…Regional relapse is one of the main failure patterns for NPC patients treated with IMRT 15 , 16 . The correct diagnosis, accurate delineation of metastatic CLNs, and radical radiation of such nodes are extremely important for the success of radiotherapy, especially when using IMRT.…”

Section: Discussionmentioning

confidence: 99%

Advantage of PET/CT in Target Delineation of MRI-negative Cervical Lymph Nodes In Intensity-Modulated Radiation Therapy Planning for Nasopharyngeal Carcinoma

Shen¹,

Xiao²,

Han³

et al. 2017

J. Cancer

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Introduction: In intensity-modulated radiation therapy (IMRT) planning for nasopharyngeal carcinoma (NPC), cervical lymph nodes (CLNs) that appear negative on magnetic resonance imaging (MRI) scans can be difficult to target. The purpose of this study was to assess the advantage of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) for distinguishing MRI-negative CLNs and the effect of 18F-FDG PET/CT on diagnosis, target delineation, and dose prescription in IMRT planning for NPC.Methods: Thirty-five NPC patients with 37 MRI-negative CLNs underwent 18F-FDG PET/CT imaging before treatment. Ultrasonography-guided fine-needle aspiration cytology (USgFNAC) was performed to examine the pathology of CLNs. The 18F-FDG PET/CT and cytopathological results were compared, and the diagnostic accuracy of 18F-FDG PET/CT was calculated. The cytopathologically confirmed CLNs were delineated and treated as the gross tumor volume of lymph nodes (denoted as GTVnd).Results: Nineteen of the 37 MRI-negative CLNs were positive on 18F-FDG PET/CT, and metastasis was confirmed by USgFNAC in 16 CLNs. Of the remaining 18 18F-FDG PET/CT-negative lymph nodes, metastasis was confirmed in one. The diagnostic accuracy, sensitivity, and specificity of 18F-FDG PET/CT were 89.2%, 94.1%, and 85.0%, respectively. The positive and negative predictive values were 84.2% and 94.4%, respectively. With a median follow-up of 48.3 months, no relapse was observed among the 18F-FDG PET/CT-positive CLNs with metastasis confirmed by USgFNAC and treated as GTVnd.Conclusion: 18F-FDG PET/CT had high accuracy, sensitivity, and specificity for distinguishing MRI-negative CLNs. 18F-FDG PET/CT-positive CLNs could reasonably be categorized as high-risk clinical tumor volume in IMRT planning for NPC.

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Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy

Cited by 23 publications

References 30 publications

A retrospective study of 606 cases of nasopharyngeal carcinoma with or without oropharyngeal candidiasis during radiotherapy

A retrospective study of 606 cases of nasopharyngeal carcinoma with or without oropharyngeal candidiasis during radiotherapy

Analysis of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma

Advantage of PET/CT in Target Delineation of MRI-negative Cervical Lymph Nodes In Intensity-Modulated Radiation Therapy Planning for Nasopharyngeal Carcinoma

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