Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

Ng, Wai‐Tong; Wong, E.; Cheung, A.; Chow, J.C.H.; Poon, Darren M.C.; Lai, Jessica W.Y.; Chiang, Chi Leung; Choi, H.L.; Chau, Tin-Ching; Lee, Victor; Lee, Anne W.M.; Tam, Anthony H.P.; Au, Kwok‐Hung

doi:10.1002/hed.25892

Cited by 34 publications

(28 citation statements)

References 23 publications

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“…Fatal complications were developed in 17 patients [carotid blowout syndrome (10), brain abscess (3), temporal lobe necrosis (1), dysphagia with aspiration pneumonia (1) and secondary malignancy (2)]. Other severe radiotherapy complications can be found in our recent published patterns of care study …”

Section: Resultsmentioning

confidence: 99%

“…We recently reported a territory‐wide study on the patterns of care and treatment outcomes of locally recurrent NPC that were initially treated with intensity modulated radiotherapy (IMRT) in Hong Kong public hospitals from 2001 to 2010 . Ninety‐seven patients were offered re‐irradiation as salvage and they were managed by various radiation doses and techniques according to attending physicians' discretion.…”

Section: Introductionmentioning

confidence: 99%

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Dose volume effects of re‐irradiation for locally recurrent nasopharyngeal carcinoma

Lee

Fung

et al. 2019

Head & Neck

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Background: This study analyzed the dose volume effects of re-irradiation for locally recurrent nasopharyngeal carcinoma (NPC) and attempts to determine the optimal dose for the best survival. Methods: Ninety-one patients were studied. The local control, fatal complication, and overall survival were analyzed against the dose (in Equivalent Dose at 2 Gy/fractions) and recurrent gross tumor volume (GTV). Results: The local control and fatal complication rate appear to increase with prescribed dose. The overall survival peaks at around 60 Gy 10 . Local control decreases significantly with increasing GTV (P < .001) while overall survival shows similar trend (P = .06). No correlation was observed between the fatal complication rate and GTV volume. The dose response of local control appears to be stronger for smaller tumors. Conclusion: GTV volume plays a significant role in local control. A 60 Gy 10 appears to be optimal for the best survival outcome; higher doses might be considered for small tumors.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dose volume effects of re‐irradiation for locally recurrent nasopharyngeal carcinoma

Lee

Fung

et al. 2019

Head & Neck

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“…The management strategy outlined above is the most commonly adopted practice in Hong Kong, as shown in a recent Patterns of Care study reported by the HKNPCSG [110]. The study included 272 locally recurrent non-metastatic NPC patients who were treated with a primary course of IMRT: their rT stage distribution was 30.5%, 9.6%, 25.4% and 34.6% for rT1, rT2, rT3 and rT4, respectively.…”

Section: Treatment Outcomesmentioning

confidence: 99%

Management of locally recurrent nasopharyngeal carcinoma

Lee

Chan

et al. 2019

Cancer Treatment Reviews

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As a consequence of the current excellent loco-regional control rates attained using the generally accepted treatment paradigms involving intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC), only 10-20% of patients will suffer from local and/or nodal recurrence after primary treatment. Early detection of recurrence is important as localized recurrent disease is still potentially salvageable, but this treatment often incurs a high risk of major toxicities. Due to the possibility of radio-resistance of tumors which persist or recur despite adequate prior irradiation and the limited tolerance of adjacent normal tissues to sustain further additional treatment, the management of local failures remains one of the greatest challenges in this disease. Both surgical approaches for radical resection and specialized re-irradiation modalities have been explored. Unfortunately, available data are based on retrospective studies, and the majority of them are based on a small number of patients or relatively short follow-up. In this article, we will review the different salvage treatment options and associated prognostic factors for each of them. We will also propose a treatment algorithm based on the latest available evidence and discuss the future directions of treatment for locally recurrent NPC. ☆ This paper was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

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“…Although excellent local control has been achieved with the wide use of intensitymodulated radiation therapy (IMRT), local recurrence remains an important cause of treatment failure in approximately 10% of advanced NPC [4][5][6]. What's worse, for patients with locally recurrent NPC, the salvage treatment options are limited and the prognosis is miserable, with 5-year overall survival ranging from 28-60% in patients with rT3-T4 disease [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A Novel Dosimetric Metrics-Based Risk Model to Predict Local Recurrence in Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiation Therapy

M.D.

Liu

et al. 2021

Preprint

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Background To develop a risk model based on dosimetric metrics to predict local recurrence in nasopharyngeal carcinoma (NPC) patients treated with intensive modulated radiation therapy (IMRT). Methods 493 consecutive patients were included, among whom 44 were with local recurrence. One-to-two propensity score matching (PSM) was used to balance variables between recurrent and non-recurrent groups. Dosimetric metrics were extracted, and critical dosimetric predictors of local recurrence were identified by Cox regression model. Moreover, recurrent sites and patterns were examined by transferring the recurrent tumor to the pretreatment planning computed tomography. Results After PSM, 44 recurrent and 88 non-recurrent patients were used for dosimetric analysis. The univariate analysis showed that eight dosimetric metrics and homogeneity index were significantly associated with local recurrence. The risk model integrating D5 and D95 achieved a C-index of 0.706 for predicting 3-year local recurrence free survival (LRFS). By grouping patients using median value of risk score, patients with risk score ˃ 0.885 had significantly lower 3-year LRFS (66.2% vs. 86.4%, p = 0.023). As for recurrent features, the proportion of relapse in nasopharynx cavity, clivus, and pterygopalatine fossa was 61.4%, 52.3%, and 40.9%, respectively; and in field, marginal, and outside field recurrence constituted 68.2%, 20.5% and 11.3% of total recurrence, respectively. Conclusions The current study developed a novel risk model that could effectively predict the LRFS in NPC patients. Additionally, nasopharynx cavity, clivus, and pterygopalatine fossa were common recurrent sites and in field recurrence remained the major failure pattern of NPC in the IMRT era.

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Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT—A study by the HKNPCSG

Cited by 34 publications

References 23 publications

Dose volume effects of re‐irradiation for locally recurrent nasopharyngeal carcinoma

Dose volume effects of re‐irradiation for locally recurrent nasopharyngeal carcinoma

Management of locally recurrent nasopharyngeal carcinoma

A Novel Dosimetric Metrics-Based Risk Model to Predict Local Recurrence in Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiation Therapy

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