Clinical Outcome and Prognostic Factors of Intensity-Modulated Radiotherapy for T4 Stage Nasopharyngeal Carcinoma

Objective. To analyze the clinical outcomes and prognostic factors of intensity-modulated radiotherapy (IMRT) for T4 stage nasopharyngeal carcinoma (NPC).Methods. Between March 2005 and March 2010, 110 patients with T4 stage NPC without distant metastases were treated. All patients received IMRT. Induction and/or concurrent chemotherapy were given. 47 (42.7%) patients received IMRT replanning.Results. The 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 90.1%, 97.0%, 67.5%, 63.9%, and 64.5%, respectively. Eleven patients experienced local-regional failure and total distant metastasis occurred in 34 patients. 45 patients died and 26 patients died of distant metastasis alone. The 5-year LRFS rates were 97.7% and 83.8% for the patients that received and did not receive IMRT replanning, respectively (P=0.023). Metastasis to the retropharyngeal lymph nodes (RLN) was associated with inferior 5-year OS rate (61.0% versus 91.7%,P=0.034). The gross tumor volume of the right/left lymph nodes (GTVln) was an independent prognostic factor for DMFS (P=0.006) and PFS (P=0.018). GTVln was with marginal significance as the prognostic factor for OS (P=0.050).Conclusion. IMRT provides excellent local-regional control for T4 stage NPC. Benefit of IMRT replanning may be associated with improvement in local control. Incorporating GTVln into the N staging system may provide better prognostic information.

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Clinical Outcomes and Prognostic Factors of 695 Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

BioMed Research International ◽

10.1155/2014/814948 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Weidong Wang ◽

Mei Feng ◽

Zixuan Fan ◽

Jie Li ◽

Jinyi Lang

Keyword(s):

Prognostic Factors ◽

Nasopharyngeal Carcinoma ◽

Clinical Outcomes ◽

Distant Metastasis ◽

Clinical Target Volume ◽

Intensity Modulated Radiotherapy ◽

Disease Free Survival ◽

Target Volume ◽

Free Survival ◽

Intensity Modulated

Objective. The 5-year clinical outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT) were evaluated.Methods. Six hundred ninety five NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from January, 2003 to December, 2006 were analyzed retrospectively, including 540 males and 155 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67–76 Gy in 30–33 fractions, positive neck lymph nodes (GTVln-R/L) 60–70 Gy in 30–33 fractions, high-risk clinical target volume (CTV1) 60–66 Gy, low-risk clinical target volume (CTV2) 54–60 Gy, and clinical target volume of cervical lymph node regions (CTVln) 50–55 Gy.Results. The 5-year local control (LC), regional control, distant metastasis-free survival (DMFS), disease free survival, disease specific survival, and overall survival (OS) rates were 89.8%, 95.2%, 74.1%, 69.6%, 83.2%, and 77.1%. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 72.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2%, respectively.Conclusion. The 5-year LC and OS rate of NPC treated with IMRT was 89.8% and 77.1%. The clinical stage, N stage, volume of GTVnx, and chemotherapy were the main prognostic factor for the OS. Distant metastasis was the main pattern of failure.

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Recurrence-free survival analysis in locally advanced pheochromocytoma: first appraisal

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab202 ◽

2021 ◽

Author(s):

Sophie Moog ◽

Frédéric Castinetti ◽

Christine DoCao ◽

Laurence Amar ◽

Julien Hadoux ◽

...

Keyword(s):

Prognostic Factors ◽

Lymph Nodes ◽

Distant Metastasis ◽

Tnm Classification ◽

Locally Advanced ◽

Recurrence Free Survival ◽

Ki 67 ◽

Multicentric Study ◽

Free Survival ◽

Catecholamine Excess

Abstract Context Locally advanced pheochromocytoma (LAP) behavior remains unknown. Objective To characterize this population and its recurrence-free survival (RFS). Design A retrospective multicentric study run within the ENDOCAN-COMETE network and GTE from 2003 to 2018. Setting 11 French Referral centers. Patients Patients with LAP as defined by capsular invasion, vascular invasion, adipose tissue invasion and/or positive locoregional lymph nodes at diagnosis without evidence of distant metastasis. Main outcome measures Recurrence was defined as the reappearance of the tumor, including local site and/or distant metastasis. The primary endpoint was RFS analysis. The secondary endpoints were characterization, overall survival (OS) and prognostic factors of recurrence. Results Among 950 patients, 90 exhibited LAP criteria (9%). 55 met the inclusion criteria (median age: 53 years-old, 61% males, 14% with a germline mutation, 84% with a catecholamine excess). LAP was defined by 31 (56%) capsular invasions, 27 (49%) fat invasions, 6 (11%) positive lymph nodes and 22 (40%) vascular invasions. After a median follow-up of 54 months (range, 6-180), 12 patients (22%) had recurrences and 3 (5%) died of a metastatic disease. Median RFS was 115 months (range, 6-168). The recurrences were local in 2 patients, distant in 2 and both local and distant in 8 patients. Median OS of patients was not reached. Size above 6.5cm (p=0.019) and Ki-67>2% (p=0.028) were identified as independent significant prognostic factors in multivariate analysis. Conclusions LAP represents 9% of pheochromocytoma’s population and is characterized by a metastatic behavior. This study paved the way of a future pathological TNM classification.

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Individualized Clinical Target Volume Delineation and Efficacy Analysis in Unilateral Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiotherapy (IMRT): 10-Year Summary and Results

10.21203/rs.3.rs-938329/v1 ◽

2021 ◽

Author(s):

De-Huan Xie ◽

Zheng Wu ◽

Wang-Zhong Li ◽

Wan-Qin Cheng ◽

Ya-Lan Tao ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Clinical Target Volume ◽

Parapharyngeal Space ◽

Intensity Modulated Radiotherapy ◽

Target Volume ◽

Recurrence Free Survival ◽

Free Survival ◽

Intensity Modulated

Abstract Purpose: To evaluate the long-term local control, failure patterns, and toxicities after individualized clinical target volume (CTV) delineation in unilateral nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).Methods: Unilateral NPC was defined as nasopharyngeal mass confined to one side of nasopharynx and did not significantly exceed the midline of nasopharyngeal apex/posterior wall. From November 2003 to December 2017, 95 patients with long-term follow-up were retrospectively included. All patients received IMRT. The CTVs were determined based on the distance from the gross tumor, the contralateral parapharyngeal space and skull base orifices were spared from irradiation.Results: There were 3 local recurrence and 8 regional recurrences in 10 patients during 84- month follow-up. All local recurrences were PGTVnx-in-field, and no recurrences in traditional high-risk area including contralateral parapharyngeal space and skull base orifices. The 10-year local-recurrence free survival, regional-recurrence free survival and overall survival were 96.2%, 90.5% and 84.7%, respectively. The dosimetry parameters of the tumor-contralateral organs were all lower than the values of the tumor-ipsilateral side (P < 0.05). The late toxicities occurred mainly in the tumor-ipsilateral organs, including radiation-induced temporal lobe injury, impaired visuality, hearing loss and subcutaneous fibrosis.Conclusion: Individualized CTV delineation in unilateral NPC could yield excellent long-term local control with limited out-of-field recurrences, reduced dose to tumor- contralateral organs and mild late toxicities, which is worthy of further exploration.

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Taxane/gemcitabine-Containing Chemotherapy Plus Locoregional IMRT for Patients With De Novo Metastatic Nasopharyngeal Carcinoma: The Treatment Outcomes and Prognostic Factors Analysis

10.21203/rs.3.rs-185761/v1 ◽

2021 ◽

Author(s):

Chengrun Du ◽

Mengshan Ni ◽

Jianyun Jiang ◽

Fangfang Kong ◽

Ruiping Zhai ◽

...

Keyword(s):

Prognostic Factors ◽

Prognostic Factor ◽

Nasopharyngeal Carcinoma ◽

Treatment Outcomes ◽

Distant Metastasis ◽

Lymphocyte Count ◽

De Novo ◽

Free Survival ◽

Metastatic Nasopharyngeal Carcinoma

Abstract Objectives: To evaluate treatment outcomes of de novo metastatic nasopharyngeal carcinoma (mNPC) patients receiving taxane/gemcitabine-containing chemotherapy followed by locoregional intensity-modulated radiotherapy (IMRT) and analyze potential prognostic factors.Materials and Methods: A total of 118 patients between March 2008 and November 2018 were retrospectively analyzed. All the patients were treated with taxane/gemcitabine-containing systemic chemotherapy followed by definitive locoregional IMRT. Potential prognostic factors including baseline absolute lymphocyte count (ALC) and the subdivision of metastasis were analyzed. Results: The median follow-up time for the whole group was 31.5 months (range, 5-138 months). Of the 118 patients, 9 (7.6%) patients experienced local regional failure and 60(50.8%) patients had progression of distant metastasis. At the time of the last follow-up, 61(51.7%) patients were dead. The 5-year actuarial progression free survival (PFS), overall survival (OS),distant metastasis relapse free survival (DMFS) and local regional recurrence free survival (LRFS) were 34.2%, 44%, 41.1% and 82.6%, respectively. Baseline lymphocyte count ≥ 1600/μl prior to the treatment conferred better locoregional control (5y-LRFS 96% vs. 64.7%, p<0.001) and distant metastasis control (5y-MFS 50.4% vs. 32.4%, p=0.023). The multivariate analysis showed that high lymphocyte count was the most relevant predictor of superior PFS (HR = 0.236, P < 0.001) and OS (HR=0.518, p= 0.04). M subdivision was found as another independent prognostic factor for OS but not for PFSConclusion: Taxane/gemcitabine-containing chemotherapy combined with IMRT represents an effective treatment modality for mNPC. Baseline ALC is an independent significant prognostic factor for PFS and OS.

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The Effect of Prolonged Duration of Intensity Modulated Radiotherapy for Nasopharyngeal Carcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.648637 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yi-Jun Hua ◽

Yan-Feng Ou-Yang ◽

Xiong Zou ◽

Le Xia ◽

Dong-Hua Luo ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Distant Metastasis ◽

Healthcare Providers ◽

Intensity Modulated Radiotherapy ◽

Progression Free Survival ◽

Primary Treatment ◽

Free Survival ◽

Intensity Modulated ◽

Distant Failure ◽

Prolonged Duration

PurposeRadiotherapy is the most important primary treatment for patients with nasopharyngeal carcinoma. Generally, the treatment duration of radiotherapy takes six or six and half weeks with 30 to 33 fractions. The current study was conducted to evaluate the association between prognosis and the duration of radiotherapy in nasopharyngeal carcinoma patients.MethodsPatients with primary nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy and concurrent cisplatin-based chemotherapy, with or without induction chemotherapy between January, 2008 and December, 2013 at a single institution were retrospectively reviewed.ResultsIn total, 1292 patients were included. At a median follow-up of 71.0 months (range 2.0–126.0 months), locoregional recurrence, distant failure and death were observed in 8.8%, 12.2% and 15.6% of all patients, respectively. Estimated 5-year locoregional relapse–free survival, distant metastasis–free survival, progression-free survival and overall survival in patients with radiation ≤ 7 weeks versus patients with radiation >7 weeks were: 93.2% versus 87.0% (P < 0.001), 89.4% versus 84.4% (P = 0.016), 79.8% versus 70.6% (P < 0.001) and 87.2% versus 78.4% (P < 0.001), respectively.ConclusionsProlonged duration of radiotherapy with a significantly higher risk of distant metastasis and death in nasopharyngeal carcinoma patients. Understanding this point, healthcare providers should make efforts to avoid prolonged duration of radiotherapy to minimize the risk of treatment failure.

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Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year Local Recurrence-Free Survival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy

Frontiers in Oncology ◽

10.3389/fonc.2021.598320 ◽

2021 ◽

Vol 11 ◽

Author(s):

Tingting Zhang ◽

Meng Xu ◽

Jinglin Mi ◽

Hui Yang ◽

Zhengchun Liu ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Local Recurrence ◽

Maximum Dose ◽

Survival Rates ◽

Intensity Modulated Radiotherapy ◽

Recurrence Free Survival ◽

Free Survival ◽

Intensity Modulated ◽

Significant Difference ◽

Local Recurrence Free Survival

ObjectiveWhether the original dosimetric constraints of neuro-optic structures (NOS) are appropriate for patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiotherapy (IMRT) remains controversial. The present study compared the survival rates and radiation-induced optic neuropathy (RION) occurrence between T4 NPC patients whose NOS were irradiated with a near maximum dose received by 2% of the volume (D2%) >55 Gy and ≤55 Gy. Moreover, the NOS dosimetric parameters and their correlation with RION occurrence were also evaluated.MethodsIn this retrospective study, 256 T4 NPC patients treated with IMRT between May 2009 and December 2013 were included. Patient characteristics, survival rates, dosimetric parameters, and RION incidence were compared between the D2% ≤55 Gy and D2% >55 Gy groups.ResultsThe median follow-up durations were 87 and 83 months for patients in the D2% >55 Gy and D2% ≤55 Gy groups, respectively. The 5-year local recurrence-free survival rates were 92.0 and 84.0% in the D2% >55 Gy and D2% ≤55 Gy groups (P = 0.043), respectively. There was no significant difference in the 5-year overall survival (OS) between both groups (D2% >55 Gy, 81.6%; D2% ≤55 Gy, 79.4%; P = 0.586). No patients developed severe RION (Grades 3–5), and there was no significant difference (P = 0.958) in the incidence of RION between the two groups. The maximum dose of NOS significantly affected the RION incidence, with a cutoff point of 70.77 Gy.ConclusionAppropriately loosening NOS dosimetric constraints in order to ensure a more sufficient dose to the target volume can provide a better 5-year local recurrence-free survival and acceptable neuro-optic toxicity in T4 NPC patients undergoing IMRT.

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Taxane/gemcitabine-containing chemotherapy plus locoregional IMRT for patients with de novo metastatic nasopharyngeal carcinoma: the treatment outcomes and prognostic factors analysis

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07192-8 ◽

2022 ◽

Author(s):

Chengrun Du ◽

Mengshan Ni ◽

Jianyun Jiang ◽

Fangfang Kong ◽

Ruiping Zhai ◽

...

Keyword(s):

Prognostic Factors ◽

Prognostic Factor ◽

Nasopharyngeal Carcinoma ◽

Treatment Outcomes ◽

Distant Metastasis ◽

Lymphocyte Count ◽

De Novo ◽

Free Survival ◽

Metastatic Nasopharyngeal Carcinoma

Abstract Purpose To evaluate treatment outcomes of de novo metastatic nasopharyngeal carcinoma (mNPC) patients receiving taxane/gemcitabine-containing chemotherapy followed by locoregional intensity-modulated radiotherapy (IMRT) and analyze potential prognostic factors. Methods A total of 118 patients between March 2008 and November 2018 were retrospectively analyzed. All the patients were treated with taxane/gemcitabine-containing systemic chemotherapy followed by definitive locoregional IMRT. Potential prognostic factors including baseline absolute lymphocyte count (ALC) and the subdivision of metastasis were analyzed. Results The median follow-up time for the whole group was 31.5 months (range 5–138 months). Of the 118 patients, 9 (7.6%) patients experienced local regional failure and 60 (50.8%) patients had progression of distant metastasis. At the time of the last follow-up, 61 (51.7%) patients were dead. The 5-year actuarial progression free survival (PFS), overall survival (OS),distant metastasis relapse free survival (DMFS) and local regional recurrence free survival (LRFS) were 34.2%, 44%, 41.1% and 82.6%, respectively. Baseline lymphocyte count ≥ 1600/μl prior to the treatment conferred better locoregional control (5y-LRFS 96% vs. 64.7%, p < 0.001) and distant metastasis control (5y-MFS 50.4% vs. 32.4%, p = 0.023). The multivariate analysis showed that high lymphocyte count was the most relevant predictor of superior PFS (HR = 0.236, p < 0.001) and OS (HR = 0.518, p = 0.04). M subdivision was found as another independent prognostic factor for OS but not for PFS. Conclusion Taxane/gemcitabine-containing chemotherapy combined with IMRT represents an effective treatment modality for mNPC. Baseline ALC is an independent significant prognostic factor for PFS and OS.

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Prognostic analysis of 152 patients with distant metastasis after intensity-modulated radiotherapy for nasopharyngeal carcinoma

10.21203/rs.3.rs-15984/v1 ◽

2020 ◽

Author(s):

Hua Yang ◽

Rui Ma ◽

Yan Zhou ◽

Yutian Yin ◽

Lina Zhao ◽

...

Keyword(s):

Prognostic Factors ◽

Liver Metastasis ◽

Adjuvant Chemotherapy ◽

Nasopharyngeal Carcinoma ◽

Distant Metastasis ◽

Survival Rates ◽

Intensity Modulated Radiotherapy ◽

Palliative Radiotherapy ◽

Intensity Modulated ◽

Organ Metastasis

Abstract Purpose The objectives of this study were to analyze the prognostic factors of patients with distant metastasis after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) and to provide a reference for the clinical treatment of these patients. Methods A retrospective analysis was conducted among 152 patients with distant metastasis after IMRT for NPC from January 2006 to December 2017 (median follow-up, 43 months). The survival rates were calculated and compared using the Kaplan-Meier method and log-rank tests, respectively. The Cox risk ratio model was used for univariateand multivariate analyses. Results Among all patients, the median interval from treatment completion to distant metastasis was 11.3 months. The median post-metastasis survival was 14 months, and the 1-, 2-, and 3-year survival rates were 60.4%, 40.2%, and 27.6%, respectively. Upon univariate analysis, overall survival was found to be related to the N stage and induction chemotherapy at initial diagnosis, time from initial radiotherapy completion to distant metastasis, liver metastasis, and chemotherapy and palliative radiotherapy after metastasis. Liver metastasis, multi-organ metastasis, chemotherapy after metastasis, and the time from radiotherapy completion to distant metastasis were independent prognostic factors for patient survival in the Cox regression analysis. Conclusions The prognosis of patients with distant metastasis after IMRT for NPC was related to the time from radiotherapy completion to distant metastasis, regardless of liver or multiple organ metastasis and adjuvant chemotherapy after metastasis. Adequate adjuvant chemotherapy and local palliative radiotherapy could potentially prolong the survival of patients with distant metastasis of NPC.

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