Prognostic value of tumor volume for patients with nasopharyngeal carcinoma treated with concurrent chemotherapy and intensity-modulated radiotherapy

Zheng, Wei; Su, Yong; Zeng, Ruolan; Gu, Mo-Fa; Huang, Shaomin

doi:10.1007/s00432-013-1542-x

Cited by 45 publications

(48 citation statements)

References 22 publications

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“…These results suggest that tumor volume may be more useful for predicting prognosis than T category in locally advanced NPC patients receiving IMRT. Similar to our results, previous studies in either the early conventional radiotherapy period [11, 12, 19, 20] or the IMRT era [10, 13, 21–24] suggested that tumor volume was an independent prognostic factor for NPC. Furthermore, the impact of GTV-P on prognosis is greater than that of T category [11].…”

Section: Discussionsupporting

confidence: 92%

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Wang

Cao

et al. 2016

Chin J Cancer

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BackgroundGross target volume of primary tumor (GTV-P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma (NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity-modulated radiotherapy (IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to find a suitable cut-off value of GTV-P for prognosis prediction.MethodsClinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver operating characteristic (ROC) curves were used to identify the cut-off values of GTV-P for the prediction of different endpoints [overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS)] and to test the prognostic value of GTV-P when compared with that of the American Joint Committee on Cancer T staging system.ResultsThe 358 patients with locally advanced NPC were divided into two groups by the cut-off value of GTV-P as determined using ROC curves: 219 (61.2%) patients with GTV-P ≤46.4 mL and 139 (38.8%) with GTV-P >46.4 mL. The 3-year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV-P ≤46.4 mL than in those with GTV-P > 46.4 mL (all P < 0.05). Multivariate analysis indicated that GTV-P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve verified that the predictive ability of GTV-P was superior to that of T category (P < 0.001). The cut-off values of GTV-P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.ConclusionIn patients with locally advanced NPC, GTV-P >46.4 mL is an independent unfavorable prognostic indicator for survival after IMRT, with a prognostic value superior to that of T category.

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Section: Discussionsupporting

confidence: 92%

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Wang

Cao

et al. 2016

Chin J Cancer

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“…[27][28][29][30][31][32][33][34][35] This finding was also a trend in this study but did not reach significance, possibly because the mean volume of our primary tumors (24.6 mL) was in the lower range of previously reported cutoff thresholds, which have ranged from 13 to 60 mL. [27][28][29][30][31][32][33][34][35] In addition, the T-stage was not significant. This finding is possibly explained by the better treatment outcomes as a result of intensity-modulated radiation therapy 36 and also the wide use of MR imaging for staging, which can lead to upstaging to T3 disease as a result of greater sensitivity to bone invasion compared with CT. 37 Histologic NPC subtype also has a major influence on treatment outcome, whereby the undifferentiated form of NPC has a better prognosis than the other subtypes.…”

Section: Discussionmentioning

confidence: 43%

Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome?

Law

King

Bhatia

et al. 2016

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Pretreatment prediction of patients with nasopharyngeal carcinoma who will fail conventional treatment would potentially allow these patients to undergo more intensive treatment or closer posttreatment monitoring. The aim of the study was to determine the ability of pretreatment DWI to predict local failure in patients with nasopharyngeal carcinoma based on long-term clinical outcome.

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“…Secondly, the sample size was not large. Moreover, recent studies have shown that primary GTV [20], the maximum primary tumour diameter [21], lactate dehydrogenase[22], and plasma Epstein-Barr virus DNA[23] were independent prognostic factors. Therefore, these items may be considered as additional factors when updating the TNM staging system.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

Liang¹,

Chen²,

Niu³

et al. 2016

PLoS ONE

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ObjectiveThe aim of this study was to compare the 2008 Chinese and the 7th edition of the American Joint Committee on Cancer (AJCC) staging systems for nasopharyngeal carcinoma and to provide proposals for updating T and N staging systems of the present staging system.MethodsBetween January 2007 and December 2012, a cohort of 752 patients with biopsy-proven, newly diagnosed, non-metastatic nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy were retrospectively analysed. Prognoses were compared by T stage, N stage, and clinical stage according to the two staging systems for overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS).ResultsIn terms of both the T and N staging systems, the two current staging systems were comparable in predicting OS. The T classification of the 2008 Chinese staging system was better in predicting LRFS, while the N classification of the 7th edition AJCC staging system was superior in predicting DMFS. In the modern era of intensity-modulated radiotherapy, the staging system should be updated by down-staging the current stage T2 to T1, and it might be rational to merge subcategories N1 and N2.ConclusionsThe two current staging systems each had advantages in predicting prognosis. It seems reasonable to downstage T2 to T1 and to merge N1 and N2.

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Prognostic value of tumor volume for patients with nasopharyngeal carcinoma treated with concurrent chemotherapy and intensity-modulated radiotherapy

Abstract: Primary gross tumor volume is an independent prognostic factor in local control, distant metastasis, disease-free survival, and overall survival in NPC. An adjusted TNM staging system that includes GTVp as a quantitative indicator to evaluate prognosis is warranted.

Cited by 45 publications

References 22 publications

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome?

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

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