Update report of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy and hypothesis of the optimal margin

Shen, Lin; Pan, Jianji; Han, Lu; Guo, Qiaojuan; Hu, Cairong; Zong, Jingfeng; Zhang, Xiuchun; Lu, Jiade J.

doi:10.1016/j.radonc.2014.01.011

Cited by 112 publications

(114 citation statements)

References 19 publications

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“…In this study, CR rate was significantly higher in the PET/CT-guided DP-IMRT group than in patients administered CT-based IMRT (99.0% vs 92.9%, P = 0.037), suggesting that the risk for local residual tumor was significantly decreased by dose escalation using the DP-IMRT technique. Our findings using a PET/CT-guided DP-IMRT regimen demonstrated that LFFS, DMFS and OS compared favorably to other reports using CT-based IMRT and chemotherapy for NPC patients [14, 28, 29]. Liu et al [28] reported that 185 patients with stage III to IVb NPC were treated by CT-based IMRT and chemotherapy.…”

Section: Discussionsupporting

confidence: 77%

“…In group B, gross tumor volume (GTV) based on CT simulation images was delineated without using the FDG-PET images for dose painting; the corresponding target volumes were derived to achieve an IMRT plan [12–14]. Hard copies of MRI scans, PET/CT images, nasopharyngeal endoscopic examination findings, and pathology reports were available to both groups of patients for consideration in defining the target volumes.…”

Section: Methodsmentioning

confidence: 99%

“…Pre-induction-chemotherapy volumes of involved lymph with extracapsular extension visualized on CT, MRI or PET-CT, and post-induction-chemotherapy volume of involved but encapsulated neck lymph nodes were used for GTVnd (GTV of the lymph node) delineation [14]. In group B, IMRT was delivered using linear accelerators with a nominal energy of 6 MV, and prescribed as follows: GTV of nasopharynx (GTVnx) was expanded outward by 5 mm (including the entire mucous membrane of the nasopharynx and 5 mm below it) [14], defined as PGTVnx, and irradiated at a dose of DT70.4 Gy/32 and DT72.6 Gy/33 Fx in patients with T1-2 and T3-4 disease, respectively, in increments of 2.2 Gy. GTV of the lymph node (GTVnd) was irradiated at a dose of 69.96–72.6Gy/32 to 33 Fx, in 2.12 to 2.2 Gy per fraction.…”

Section: Methodsmentioning

confidence: 99%

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PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

Liu

Wang

et al. 2017

Radiat Oncol

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BackgroundThe effect of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT)-guided dose-painting intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) is unclear. This study aimed to assess the efficacy and toxicity of such combination.MethodsFrom 2012 to 2014, 213 patients with stage III-IVB NPC received chemoradiotherapy by PET/CT-guided DP-IMRT (group A, n = 101) or CT-based IMRT (group B, n = 112). In group A, subvolume GTVnx-PET (gross tumor volume of nasopharynx in PET images) was defined within GTVnx (gross tumor volume of nasopharynx) as the SUV50%max isocontour; the dose to GTVnx-PET was escalated to DT 75.2 Gy/32 and 77.55 Gy/33 Fx, respectively, for patients with T1-2 and T3-4 disease, respectively. In group B, PGTVnx was irradiated at DT 70.4–72.6 Gy/32–33 Fx in 2.2 Gy per fraction.ResultsComplete response rates were 99.0% (100/101) and 92.9% (104/112) in groups A and B, respectively (P = 0.037). Compared with CT-based IMRT, FDG-PET/CT guided DP-IMRT significantly improved 3-year local failure-free survival (LFFS, 98.8% vs. 91.3%; P = 0.032), locoregional failure-free survival (LRFFS, 97.2 vs. 91.2%; P = 0.049), distant metastasis-free survival (DMFS, 92.9% vs. 87.4%; P = 0.041), disease free survival (DFS, 87.9% vs. 82.4%; P = 0.02), and overall survival (OS, 91.8% vs. 82.6%; P = 0.049). No statistically significant differences in acute and late toxic effects were observed. Multivariate analysis showed that dose painting (PET/CT-guided DP-IMRT vs CT-based IMRT without DP) was a significant independent prognostic factor for LFFS and DFS.ConclusionFDG-PET/CT guided DP-IMRT plus chemotherapy is associated with a considerable survival benefit, without increasing toxicity in patients with locoregional advanced NPC. Further randomized trials are needed to fully assess the role of PET/CT-guided DP-IMRT.

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Section: Discussionsupporting

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

Liu

Wang

et al. 2017

Radiat Oncol

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“…Sun et al [12] reported that LFFS were significantly different among groups of patients with different T classifications except groups of patients with T1 and T2 classification, whereas two other studies indicated that T classification was not an independent prognostic factor for local control [13,14]. In a study [15] of head and neck squamous cell carcinoma treated by radical radiotherapy, patients receiving higher doses (≥ 66 Gy) had better outcomes than those that received lower doses.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging–Detected Intracranial Extension in the T4 Classification Nasopharyngeal Carcinoma with Intensity-Modulated Radiotherapy

et al. 2017

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PurposeThis study was conducted is to identify the prognostic value and staging categories of magnetic resonance imaging (MRI)–detected intracranial extension in nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT) to determine whether it is necessary to subclassify the T4 classification NPC.Materials and MethodsA total of 335 nonmetastatic T4 classification NPC patients with MRI treated between March 2004 and June 2011 by radical IMRT were included. The T4 classification patients were subclassified into two grades (T4a, without intracranial extension vs. T4b, with intracranial extension) according to the site of invasion.ResultsThe frequency of intracranial extension was 40.9% (137 of 335 patients). Multivariate analysis identified subclassification (T4a vs. T4b) as an independent prognostic factor for local failure-free survival (p=0.049; hazard ratio [HR], 0.498) and overall survival (p=0.004; HR, 0.572); however, it had no effect on regional failure-free survival or distant failure-free survival (p > 0.050).ConclusionFor patients with T4 classification NPC, those with MRI-detected intracranial extension are more likely to experience local failure and death after IMRT than patients without intracranial extension. According to the site of invasion, subclassification of T4 patients as T4a or T4b has prognostic value in NPC.

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“…With the extensive use of intensity modulated radiation therapy (IMRT), even in locally advanced NPC, the 5-year local control rate has exceeded 90% [4,5]. Therefore, the short comings of the current TNM staging system in predicting the prognosis have been found and proposals for revisions in the next edition have been raised in recent studies [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system

et al. 2015

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Update report of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy and hypothesis of the optimal margin

Cited by 112 publications

References 19 publications

PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

Magnetic Resonance Imaging–Detected Intracranial Extension in the T4 Classification Nasopharyngeal Carcinoma with Intensity-Modulated Radiotherapy

Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma: Validation of the 7th edition AJCC staging system

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