Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: The Hong Kong experience

Kam, Michael K.M.; Teo, Peter M.L.; Chau, R.M.W.; Cheung, K.Y.; Choi, Peter; Kwan, W. H.; Leung, Sing-fai; Zee, Benny; Chan, Anthony T.C.

doi:10.1016/j.ijrobp.2004.05.022

Cited by 483 publications

(332 citation statements)

References 35 publications

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“…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

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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.

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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

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“…They concluded that IMRT provides better tumor target coverage with significantly better sparing of sensitive normal tissue structures in the treatment of locally advanced nasopharyngeal carcinoma. Another dose distribution study, by Kam et al [31,32] from Hong Kong, compared IMRT with 2D-radiotherapy (2D-RT) and 3D-CRT treatment plans. Three patients with different stages, including T1N0, T2bN2, and T4N2, were compared.…”

Section: Imrt For Nasopharyngeal Carcinomamentioning

confidence: 99%

Intensity-Modulated Radiation Therapy for Head and Neck Carcinoma

et al. 2007

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After completing this course, the reader will be able to:1. Outline innovations related to targeted radiation therapy.2. Describe trials proving an advantage using IMRT.3. Assess treatment planning modalities and how IMRT fields are designed.4. Evaluate when there is a toxicity advantage for IMRT.5. Discern when conventional radiotherapy should be used instead of IMRT.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACT Intensity-modulated radiation therapy (IMRT) for head and neck tumors refers to a new approach that aims at increasing the radiation dose gradient between the target tissues and the surrounding normal tissues at risk, thus offering the prospect of increasing the locoregional control probability while decreasing the complication rate. As a prerequisite, IMRT requires a proper selection and delineation of target volumes. For the latter, recent data indicate the potential of functional imaging to complement anatomic imaging modalities. Nonrandomized clinical series in paranasal sinuses and pharyngolaryngeal carcinoma have shown that IMRT was able to achieve a very high rate of locoregional control with less morbidity, such as dry-eye syndrome, xerostomia, and swallowing dysfunction. The promising results of IMRT are likely to be achieved when many treatment conditions are met, for example, optimal selection and delineation of the target volumes and organs at risk, appropriate physical quality control of the irradiation, and accurate patient setup with the use of onboard imaging. Because of the complexity of the various tasks, it is thus likely that these conditions will only be

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“…Certain surgeons have developed SMG-transfer surgery to preserve the SMG and this procedure achieves good results (11,12), but the invasiveness limits its use in clinical practice. In the IMRT era, numerous studies identified the importance of SMG protection as it was observed that xerostomia could not be sufficiently reduced when the parotid gland was well preserved and the SMG was not (13)(14)(15)(16). In principle, determining the target volume for the level Ib lymph node is problematic.…”

Section: Introductionmentioning

confidence: 99%

A risk score model for the metastasis of level Ib lymph node based on the clinicopathological features of nasopharyngeal carcinoma in a large sample

Liu

et al. 2014

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to develop a metastatic risk score model of neck level Ib lymph nodes in primary nasopharyngeal carcinoma (NPC) to guide the level Ib radiotherapy. There were a total of 1,557 patients enrolled in the study, and of these patients, 1,145 were included in the training set. Univariate χ 2 analysis and multivariate logistic regression analyses were used to screen the independent risk factors to construct the risk score model. A total of 85 patients in the validating set underwent a pathology biopsy of level Ib lymph nodes to test the model. The remaining 327 patients from the prognostic-research set were used to evaluate the prognostic impact of level Ib irradiation in high-and low-risk groups. The independent risk factors in the model were carotid sheath involvement, the maximal diameter of the neck lymph nodes (≥20 mm) and the involvement of the level II/III/IV lymph nodes. The involvement of level IV was assigned score 2 and the other risk factors were assigned score 1. According to the total scores, the patients were divided into the low-(total score, 0-1; level Ib metastasis rate, 0.5%) and high-risk groups (total score, 2-4; level Ib metastasis rate, 8.5%). In the validating set, the metastatic rate of level Ib in 43 low-risk patients was 0%, and the rate was 31.0% (13/42) in 42 high-risk patients. In the prognostic-research set, the prognosis of 137 low-risk patients was not affected by level Ib irradiation. However, level Ib unirradiation was an independent prognostic factor for the locoregional recurrence in 190 high-risk patients. According to the data, the novel score model could help assess the metastatic risk of level Ib in primary NPC, and the radiotherapy on level Ib may impact the locoregional recurrence in high-risk patients.

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Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: The Hong Kong experience

Cited by 483 publications

References 35 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

Intensity-Modulated Radiation Therapy for Head and Neck Carcinoma

A risk score model for the metastasis of level Ib lymph node based on the clinicopathological features of nasopharyngeal carcinoma in a large sample

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Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: The Hong Kong experience

Cited by 483 publications

References 35 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

Intensity-Modulated Radiation Therapy for Head and Neck Carcinoma

A risk score model for the metastasis of level Ib lymph node based on the clinicopathological features of nasopharyngeal carcinoma in a large sample

Contact Info

Product

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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