Prognostic factors of 305 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy

Han, Lu; Shen, Lin; Pan, Jianji; Chen, Chuanben; Zhang, Yu; Zhang, Xiuchun; Liao, Xin; Chen, Qisong

doi:10.5732/cjc.009.10332

Cited by 58 publications

(49 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hence, it enables the delivery of high radiation dose to the targets without jeopardizing the radiosensitive organs, thereby reducing treatment complications and improving the quality of life. A serial of studies were conducted to investigate the potential benefits of IMRT, using simultaneous integrated multi-target treatment technique (SIMT-IMRT) over highly optimized conventional 3D CRT combined with intracavitary brachytherapy for the treatment of NPC, and came to the same conclusion that a good therapeutic ratio could be achieved with the use of IMRT (Kam et al, 2004;Wolden et al, 2006;TaheriKadkhoda et al, 2008;Tham et al, 2009;Han et al, 2010;Wong et al, 2010). Moreover, the severity of xerostomia, neck fibrosis and trismus, and the incidences of xerostomia at 6 months and 1, 2, 3, 4 years after treatment were significantly reduced in IMRT group than in CRT group (Lai et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Long Term Outcomes and Prognostic Factors of N₀Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Sun

Chen²,

Chen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Treatment responses of N 0 stage nasopharyngeal carcinoma were firstly analyzed comprehensively to evaluate long term outcomes of patients and identify prognostic factors. A total of 610 patients with N 0 NPC, undergoing definitive radiotherapy to their primary lesion and prophylactic radiation to upper neck, were reviewed retrospectively. Concomitant chemotherapy was administrated to 65 out of the 610. Survival rates of the patients were calculated using the Kaplan-Meier method and compared by log-rank test. Prognostic factors were identified by the Cox regression model. The study revealed the 5-year and 10-year overall, disease-free, disease-specific, local failure-free, regional failure-free, locoregional failure-free and distant metastasis-free survival rates to be 78.7% and 66.8%, 68.8% and 55.8%, 79.9% and 70.4%, 81.2% and 72.5%, 95.8% and 91.8%, 78.3% and 68.5%, 88.5% and 85.5%, respectively. There were 192 patients experiencing failure (31.5%) after radiotherapy or chemoradiotherapy. Of these, local recurrence, regional relapse and distant metastases as the first event of failure occurred in 100 (100/610, 16.4%), 15(15/610, 2.5%) and 52 (52/610, 8.5%), respectively. Multivariate analysis showed that T stage was the only independent prognostic factor for patients with N 0 NPC (P=0.000). Late T stage (P=0.000), male (P=0.039) and anemia (P=0.007) were independently unfavorable factors predicting disease-free survival. After treatment, satisfactory outcome wasgenerally achieved in patients with N 0 NPC. Local recurrence represented the predominant mode of treatment failure, while T stage was the only independent prognostic factor for overall survival. Late T stage, male gender, and anemia independently predicted lower possibility of the disease-free survival.

show abstract

Section: Discussionmentioning

confidence: 99%

Long Term Outcomes and Prognostic Factors of N₀Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Sun

Chen²,

Chen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

show abstract

“…CT scans are the standard imaging modality used in radiation treatment planning as they provide a [89] 63 I-IV 30% 92% (3 years) 90% (3 years) 23% Wolden et al [90] 74 I-IV 93% 91% (3 years) 83% (3 years) 32% Lai et al [91] 512 I-IV 82% 93% (5 years) 76% (5 years) NR Han et al [92] 305 I-IV 85% 98% (3 years) 89% (3 years) 7% Lin S [93] 323 II-IV 90% 98% (3 years) 90% (3 years) 8%…”

Section: Target Volume Delineationmentioning

confidence: 99%

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Bhide

Newbold²,

Harrington³

et al. 2012

BJR

View full text Add to dashboard Cite

ABSTRACT. Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional two-dimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. Intensity-modulated radiotherapy (IMRT) can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This article reviews the current role of IMRT in head and neck cancer from the point of view of normal tissue sparing, and also reviews the current published literature by individual head and neck cancer subsites. In addition, we briefly discuss the role of image guidance in head and neck IMRT, and future directions in this area. Intensity-modulated radiotherapy (IMRT) is an advanced approach to three-dimensional (3D) treatment planning and conformal therapy. It optimises the delivery of irradiation to irregularly shaped volumes and has the ability to produce concavities in radiation treatment volumes. For head and neck cancer, the clinical target volume 1 (CTV1), which includes the primary tumour and the involved nodes, typically receives a higher radiation dose than CTV2. The different doses to CTV1 and 2 can be delivered simultaneously, while sparing the parotid salivary glands and the spinal cord. In the head and neck region, IMRT has a number of potential advantages: (i) it allows for greater sparing of normal structures such as salivary glands, oesophagus, optic nerves, brain stem and spinal cord [7,8]; (ii) it allows treatment to be delivered in a single treatment phase without the requirement for matching additional fields to provide tumour boosts, and eliminates the need for electron fields to the posterior (levels II and V) neck nodes; and (iii) it offers the possibility of simultaneously delivering higher radiation doses to regions of gross disease and lower doses to areas of microscopic disease-the so-called simultaneous integrated boost (SIB) IMRT [9].IMRT can be delivered using linear accelerators with static multileaf collimators (MLCs; step and shoot IMRT) or dynamic leaf MLCs, tomotherapy machines or volumetric modulated arc therapy (VMAT). Tomotherapy enables the simultaneous use of image guidance and treatment delivery [10]. However, adaptive RT based on image guidance is yet to be clinically optimised in head and neck cancer. VMAT is a newer technique of delivering IMRT. VMAT delivers IMRT-like distributions in a single rotation of the gantry, varying the gantry speed and dose rate during delivery, in contrast to standard IMRT, which uses fixed gantry beams. Planning studies using RT demonstrate shorter planning and treatment time, fewer monitor units for treatment delivery and better dose homogeneity and normal tissue sparing [11,12]. There is a lack of data as regards clinical implementation of this technique.IMRT was first described in 1999; in the last decade numerous retrospective case series (single and multiinstitution) and a few randomised trials have been published studying the clinical implementation of thi...

show abstract

“…Available data from other IMRT studies including those from China reported a rate of between 4.5-5.1% for severe skin reaction (Lin et al, 2009;Han et al, 2010;Lu et al, 2010;Wang et al, 2012). However, data from Hong Kong reported a higher rate ranging from 13-46% (Kwong et al, 2006;Ng et al, 2011).…”

Section: Discussionmentioning

confidence: 97%

“…Another IMRT study in Hong Kong with 50 patients had 78% of their patients having severe acute toxicity with one treatment related death (Kwong et al, DOI:http://dx.doi.org/10.7314/APJCP.2012.13.7.3287 Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience 2006. However, IMRT studies on NPC patients in China reported a lower rate of severe acute toxicities ranging from 17.5-40.6% (Lin et al, 2009;Han et al, 2010;Wang et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Recent IMRT studies in Hong Kong had rates between 65-78% (Kwong et al, 2006;Ng et al, 2011). However, the studies in China reported lower rates ranging from 3.2-29.5% ( (Lin et al, 2009;Han et al, 2010;Lu et al, 2010;Wang et al, 2012). Regardless, it is clear that maximal dietary support, and in many cases nasogastric tube feeding will be required, for the successful implementation of IMRT treatment for NPC more so if we wish to complete the treatment within the stipulated OTT.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience

Phua

Tan²,

Tan³

et al. 2012

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Purpose: To study the overall treatment time (OTT) and acute toxicity of intensity-modulated radiotherapy (IMRT) treatment for nasopharyngeal carcinoma (NPC). Methods: This retrospective study covered all NPC patients who underwent radical IMRT treatment at the Penang General Hospital from June 2011 to February 2012. Patients of any age and stage of disease with histologically proven diagnosis were included. Information was collected on patient demographics, clinical stage, treatment received, including any neoadjuvant and/or concurrent chemotherapy, acute toxity and completion of IMRT within the OTT. Results: A total of 26 NPC patients were treated with IMRT during the study period; 88.5% had stage III/IV disease. 45.2% received neo-adjuvant chemotherapy while 50.0% were given concurrent chemo-irradiation. All patients completed the treatment and 92.3% within the 7 weeks OTT. Xerostomia was present in all patients with 92.3% having grade 2. Severe grade III/IV acute toxicity occurred in 73.1% of patients, the commonest of which was oral mucositis (57.6%). This was followed by dysphagia which occurred in 53.8%, skin reactions in 42.3% and weight loss in 19.2%. However, haematological toxicity was mild with only one patient having leucopaenia. Conclusion: IMRT treatment for NPC is feasible in our center. More importantly, it can be delivered within the 7 weeks OTT in the majority of patients. Severe grade 3/4 toxicity is very common (73.1%) and thus maximal nutritional and analgesic support is required throughout the treatment.

show abstract

Prognostic factors of 305 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy

Cited by 58 publications

References 12 publications

Long Term Outcomes and Prognostic Factors of N₀Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Long Term Outcomes and Prognostic Factors of N₀Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience

Contact Info

Product

Resources

About

Prognostic factors of 305 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy

Cited by 58 publications

References 12 publications

Long Term Outcomes and Prognostic Factors of N0Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Long Term Outcomes and Prognostic Factors of N0Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience

Contact Info

Product

Resources

About

Long Term Outcomes and Prognostic Factors of N₀Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients

Long Term Outcomes and Prognostic Factors of N₀Stage Nasopharyngeal Carcinoma: a Single Institutional Experience with 610 Patients