Value of intensity modulated radiotherapy for local control and salivary flow compared with conventional radiotherapy for stage II nasopharyngeal carcinoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6036-6036 ◽  
Author(s):  
D. L. Kwong ◽  
A. McMillan ◽  
E. Pow ◽  
J. Sham
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Local Control ◽  
Survival Rates ◽  
Intensity Modulated Radiotherapy ◽  
Salivary Flow ◽  
Parotid Glands ◽  
Median Dose ◽  
Conventional Radiotherapy ◽  
Intensity Modulated ◽  
Significant Difference

6036 Background: Xerostomia is ubiquitous after conventional radiotherapy (CRT) for nasopharyngeal carcinoma (NPC). Intensity modulated radiotherapy (IMRT) has been advocated to spare the parotids for early disease. However, in T2 disease where there is a need to cover parapharyngeal involvement, it is uncertain if IMRT can still preserve salivary function without compromising local control. Methods: Patients with T2N0/1M0 NPC to be treated with RT alone were eligible. Patients were randomized to receive CRT or IMRT. The end points were salivary flow and local control. The aim was to recruit 25 patients for salivary flow study in each arm. All patients underwent stimulated parotid (SPS) and whole salivary (SWS) flow assessment before RT and at 2, 6 and 12 months after RT. Results: From 2000 to 2005, 42 and 40 patients were randomized to IMRT and CRT respectively. 19 (47.5%) and 27 (64.3%) of patients treated with CRT and IMRT had N1 disease respectively (p=0.18). The median dose for CRT patients was 68 Gy and 75% patients received additional parapharyngeal boost dose of 10 Gy. The median dose to NP for patient treated with IMRT was 70 Gy with no additional boost. Disease control and survival rates were shown in the Table. 25 patients in each arm underwent prospective salivary flow assessment. There was gradual recovery of SWS and SPS among patients treated with IMRT while patient on CRT showed no improvement over time. The mean SWS and SPS flow at 12 months were 26% and 114% of baseline among patients treated with IMRT, compared with 5% and 0% among patients treated with CRT. There was significant difference in SWS and SPS between patients treated with IMRT and CRT at 2, 6 and 12 months post-RT. The average mean dose to parotid gland was 41Gy. Conclusions: IMRT can reserve salivary flow despite a relatively high mean dose to the parotid glands. The significant improvement in local control with IMRT was unexpected but can be due to better coverage of disease with 3-dimensional planning. No significant financial relationships to disclose.

scholarly journals 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

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.

scholarly journals Induction Chemotherapy Combined With Intensity-Modulated Radiotherapy for 129 Nasopharyngeal Carcinoma Patients With Synchronous Metastases: A Retrospective Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Mengshan Ni ◽  
Lijun Geng ◽  
Fangfang Kong ◽  
Chengrun Du ◽  
Ruiping Zhai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Nasopharyngeal Carcinoma ◽  
Induction Chemotherapy ◽  
Survival Rates ◽  
Intensity Modulated Radiotherapy ◽  
Initial Diagnosis ◽  
Intensity Modulated ◽  
Synchronous Metastases ◽  
Pre Treatment

ObjectiveTo analyze the therapeutic effect and prognostic factors of nasopharyngeal carcinoma (NPC) patients with distant metastases at initial diagnosis receiving induction chemotherapy with intensity-modulated radiotherapy (IMRT).MethodsA total of 129 patients who underwent platinum-based induction chemotherapy followed by definitive IMRT with or without concurrent or adjuvant chemotherapy for newly diagnosed distant metastatic NPC in our center between March 2008 and November 2018 were retrospectively analyzed. 41 patients underwent local therapy for metastatic sites. Kaplan-Meier method was used to estimate survival rates, Log-rank test and Cox proportional hazards model were used to figure out independent prognostic factors of overall survival (OS).ResultsA total of 66 patients had been dead (median follow-up time, 51.5 months). The median overall survival (OS) time was 54.2 months (range, 7-136 months), and the 1-year, 2-year, 3-year, 5-year overall survival rates were 88.0%,71.0%,58.0%, and 47.0%. Multivariate analysis found that the factors correlated with poor overall survival were pre-treatment serum lactate dehydrogenase (SLDH) >180U/L, chemotherapy cycles<4, and M1 stage subdivision (M1b, single hepatic metastasis and/or multiple metastases excluding the liver; and M1c, multiple hepatic metastases). The 5-year OS rates for M1a, M1b and M1c were 62.6%,40.4% and 0%, respectively.ConclusionPlatinum-containing induction chemotherapy combined with IMRT seemed to be advantageous to prolong survival for some NPC patients with synchronous metastases at initial diagnosis. The independent factors to prognosticate OS were pre-treatment SLDH, number of chemotherapy cycles, and M1 subcategories. Prospective clinical trials are needed to confirm the result.

scholarly journals Short-term efficacy comparison between helical tomotherapy and intensity-modulated radiotherapy in patients with locally advanced nasopharyngeal carcinoma

2020 ◽  
Author(s):  
Zhen Cui ◽  
Jia Liu ◽  
Qiaoyu Sun ◽  
Chaoge Wang ◽  
Meifang Fang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Planning Target Volume ◽  
Helical Tomotherapy ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Target Volume ◽  
Short Term ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Better Than

Abstract Background: To evaluate short-term safety and efficacy of helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).Methods: Retrospective analysis of locally advanced nasopharyngeal carcinoma treated with radiotherapy and concurrent platinum based neoadjuvant chemotherapy (cisplatin 80 mg/m2 every 3 weeks for 1 cycle) in our hospital from February 2017 to October 2019, including 70 patients in HT group and 70 in IMRT group. The target area of ​​the tumor was delineated by magnetic resonance (MRI) imaging. The prescription doses delivered to the gross tumor volume (pGTVnx) and positive lymph nodes (pGTVnd), the high risk planning target volume (PTV1), and the low risk planning target volume (PTV2), were 69.96 Gy, 66-70 Gy, 60 Gy and 50-54 Gy, in 33 fractions, respectively. Acute reactions were evaluated according to the RTOG/EORTC criteria, whereas the therapeutic efficacy was assessed according to RECTST version 1.1 criteria in a 3-months period.Results: The CI of PGTVnx, PGTVnd, PTV1 and PTV2, and HI of PGTVnx, PTV1 and PTV2 in HT group was significantly better than those in IMRT group. The OAR Dmax and Dmean in HT group were better than those in IMRT group with a significant difference (all p <0.05). Patients in the HT group were significantly better than those in the IMRT group in the protection of acute parotid gland injury and hearing damage (p <0.05), but not other acute adverse reaction. No significant difference was found on the short-term efficacy illustrated by ORR between HT group and IMRT group (x2 = 0.119; p = 0.730).Conclusions: Compared with IMRT, HT has better radiophysical-related dosimetric advantages in radiotherapy for locally advanced nasopharyngeal carcinoma. Despite similar on short-term effects, HT has lower incidence of adverse reactions than IMRT.

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