Patterns of Local-regional Failure After Primary Intensity Modulated Radiotherapy for Nasopharyngeal Carcinoma

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2014 Feb 21

PMID 24552293

Citations 28

Authors

Fangfang Kong

Hongmei Ying

Chengrun Du

Shuang Huang

Junjun Zhou

Junchao Chen

Lining Sun

Xiaohui Chen

Chaosu Hu

Affiliations

Soon will be listed here.

Abstract

Background: To analyze patterns of local-regional failure after primary intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).

Methods: A total of 370 non-metastatic NPC patients consecutively treated with IMRT (with or without chemotherapy) were analyzed. Radiotherapy was administered using a simultaneous integrated boost (SIB) technique at the total prescribed dose of 66-70.4 Gy (2.0-2.2 Gy per fraction). The location and extent of local-regional failures were transferred to the pretreatment planning computed tomography (CT) for dosimetric analysis. The dose of radiation received by V(recur) (volume of recurrence) was calculated and analyzed with dose-volume histogram (DVH). Failures were classified as: "in field" if 95% of V(recur) was within the 95% isodose, "marginal" if 20% to 95% of V(recur) was within the 95% isodose, or "outside" if less than 20% of V(recur) was inside the 95% isodose.

Results: With a median follow up of 26 months, 25 local-regional failures were found in 18 patients. The 1- and 2-year actuarial local-regional control rates for all patients were 99.7% and 95.5% respectively. Among the 22 local-regional failures with available diagnostic images, 16 (64%) occurred within the 95% isodose lines and were considered in-field failures; 3 (12%) were marginal and 3 (12%) were outside-field failures.

Conclusions: Intensity-modulated radiotherapy provides excellent local-regional control for NPC. In-field failures are the main patterns for local-regional recurrence. Reducing the coverage of critical adjacent tissues in CTV purposefully for potential subclinical diseases was worth of study. Great attention in all IMRT steps is necessary to reduce potential causes of marginal failures. More studies about radioresistance are needed to reduce in-field failures.

Citing Articles

Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy.

Xiao X, Zou S, Chen Y, Guo R, Tang L, Sun Y J Cancer. 2024; 15(2):456-465.

PMID: 38169541 PMC: 10758024. DOI: 10.7150/jca.88148.

Radiation-induced nasopharyngeal ulcers after re-irradiation with intensity-modulated radiotherapy in locoregional recurrent nasopharyngeal carcinoma patients: a dose-volume-outcome analysis.

Ni M, Kong F, Pan G, Du C, Zhai R, Hu C Eur Arch Otorhinolaryngol. 2023; 281(3):1425-1434.

PMID: 37995006 DOI: 10.1007/s00405-023-08330-0.

Nasopharyngeal carcinoma. A "different" head and neck tumour. Part B: treatment, prognostic factors, and outcomes.

Cantu G Acta Otorhinolaryngol Ital. 2023; 43(3):155-169.

PMID: 37204840 PMC: 10198365. DOI: 10.14639/0392-100X-N2223.

Unraveling the patterns and pathways of local recurrence of nasopharyngeal carcinoma: evidence for individualized clinical target volume delineation.

Ou X, Yan W, Huang Y, He X, Ying H, Lu X Radiat Oncol. 2023; 18(1):55.

PMID: 36944958 PMC: 10032020. DOI: 10.1186/s13014-023-02199-3.

Biological target volume based on fluorine-18-fluorode-oxyglucose positron emission tomography/computed tomography imaging: a spurious proposition?.

Xu T, Feng Y, Hong H, Xu Y, Chen J, Qiu X Radiat Oncol. 2023; 18(1):32.

PMID: 36810119 PMC: 9942280. DOI: 10.1186/s13014-023-02225-4.

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