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Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy.

Wee CW, Keam B, Heo DS, Sung MW, Won TB, Wu HG - Radiat Oncol J (2015)

Bottom Line: Weekly cisplatin was used as concurrent chemotherapy.Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity.However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated.

Materials and methods: Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy.

Results: With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

Conclusion: CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

No MeSH data available.


Related in: MedlinePlus

An example of target volume delineation for intensity-modulated radiotherapy. A 61-year-old male had a primary lesion involving the bilateral nasopharyngeal mucosa and central skull base, and multiple clinically involved lymph nodes at bilateral level II and right level III (clinical stage T3N2 according to the American Joint Committee on Cancer staging system 7th edition). Level IV and V cervical chains were not involved. (A) The high-risk clinical tumor volume (CTV, orange line) is created by 5-mm auto-expansion margin around the gross tumor volume (red line). The intermediate-risk CTV (blue line) is further expanded with a 5-mm margin around the high-risk CTV of the primary lesion, encompassing the involved cervical nodal stations and areas of high-risk. Bilateral retropharyngeal nodes and the entire nasopharyngeal mucosa are routinely included in the intermediate-risk CTV. The low-risk CTV (cyan line) includes the remnant cervical lymph nodes. (B) Images of fluorodeoxyglucose positron emission tomography taken before concurrent chemoradiation at a similar level to the displayed target volumes.
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Figure 1: An example of target volume delineation for intensity-modulated radiotherapy. A 61-year-old male had a primary lesion involving the bilateral nasopharyngeal mucosa and central skull base, and multiple clinically involved lymph nodes at bilateral level II and right level III (clinical stage T3N2 according to the American Joint Committee on Cancer staging system 7th edition). Level IV and V cervical chains were not involved. (A) The high-risk clinical tumor volume (CTV, orange line) is created by 5-mm auto-expansion margin around the gross tumor volume (red line). The intermediate-risk CTV (blue line) is further expanded with a 5-mm margin around the high-risk CTV of the primary lesion, encompassing the involved cervical nodal stations and areas of high-risk. Bilateral retropharyngeal nodes and the entire nasopharyngeal mucosa are routinely included in the intermediate-risk CTV. The low-risk CTV (cyan line) includes the remnant cervical lymph nodes. (B) Images of fluorodeoxyglucose positron emission tomography taken before concurrent chemoradiation at a similar level to the displayed target volumes.

Mentions: The gross tumor volume (GTV) of the primary site and neck included all disease visualized on either CT or MRI, as well as suspicious areas on physical and endoscopic exams. The high-risk clinical target volume (CTV) was defined using three-dimensional auto-expansion of 5 mm around the GTV and modifying it regarding anatomical architecture. The intermediate-risk CTV included the high-risk CTV with an additional 5-mm margin plus bilateral retropharyngeal nodes and involved cervical nodal stations with or without one subsequent uninvolved cervical nodal station, depending on the physician's decision. The intermediate-risk CTV also encompassed the entire nasopharyngeal mucosa and suspicious areas at risk among the skull base, parapharyngeal spaces, inferior sphenoid sinuses, posterior nasal cavity, posterior maxillary sinuses, and the cavernous sinuses. The low-risk CTV included bilateral cervical nodes not covered by the high- or intermediate-risk CTV (Fig. 1). Level IA and IB cervical nodal areas were not included in any CTV unless there was clinical evidence of involvement. The high-, intermediate-, and low-risk PTVs were created by 3 mm auto-expansion (except one patient with 2 mm auto-expansion) of the high-, intermediate-, and low-risk CTVs, respectively, and were restricted to the body. Doses of 67.5 Gy, 54-60 Gy, and 48 Gy in 30 daily fractions were applied to the high-, intermediate-, and low-risk PTVs, respectively.


Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy.

Wee CW, Keam B, Heo DS, Sung MW, Won TB, Wu HG - Radiat Oncol J (2015)

An example of target volume delineation for intensity-modulated radiotherapy. A 61-year-old male had a primary lesion involving the bilateral nasopharyngeal mucosa and central skull base, and multiple clinically involved lymph nodes at bilateral level II and right level III (clinical stage T3N2 according to the American Joint Committee on Cancer staging system 7th edition). Level IV and V cervical chains were not involved. (A) The high-risk clinical tumor volume (CTV, orange line) is created by 5-mm auto-expansion margin around the gross tumor volume (red line). The intermediate-risk CTV (blue line) is further expanded with a 5-mm margin around the high-risk CTV of the primary lesion, encompassing the involved cervical nodal stations and areas of high-risk. Bilateral retropharyngeal nodes and the entire nasopharyngeal mucosa are routinely included in the intermediate-risk CTV. The low-risk CTV (cyan line) includes the remnant cervical lymph nodes. (B) Images of fluorodeoxyglucose positron emission tomography taken before concurrent chemoradiation at a similar level to the displayed target volumes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493434&req=5

Figure 1: An example of target volume delineation for intensity-modulated radiotherapy. A 61-year-old male had a primary lesion involving the bilateral nasopharyngeal mucosa and central skull base, and multiple clinically involved lymph nodes at bilateral level II and right level III (clinical stage T3N2 according to the American Joint Committee on Cancer staging system 7th edition). Level IV and V cervical chains were not involved. (A) The high-risk clinical tumor volume (CTV, orange line) is created by 5-mm auto-expansion margin around the gross tumor volume (red line). The intermediate-risk CTV (blue line) is further expanded with a 5-mm margin around the high-risk CTV of the primary lesion, encompassing the involved cervical nodal stations and areas of high-risk. Bilateral retropharyngeal nodes and the entire nasopharyngeal mucosa are routinely included in the intermediate-risk CTV. The low-risk CTV (cyan line) includes the remnant cervical lymph nodes. (B) Images of fluorodeoxyglucose positron emission tomography taken before concurrent chemoradiation at a similar level to the displayed target volumes.
Mentions: The gross tumor volume (GTV) of the primary site and neck included all disease visualized on either CT or MRI, as well as suspicious areas on physical and endoscopic exams. The high-risk clinical target volume (CTV) was defined using three-dimensional auto-expansion of 5 mm around the GTV and modifying it regarding anatomical architecture. The intermediate-risk CTV included the high-risk CTV with an additional 5-mm margin plus bilateral retropharyngeal nodes and involved cervical nodal stations with or without one subsequent uninvolved cervical nodal station, depending on the physician's decision. The intermediate-risk CTV also encompassed the entire nasopharyngeal mucosa and suspicious areas at risk among the skull base, parapharyngeal spaces, inferior sphenoid sinuses, posterior nasal cavity, posterior maxillary sinuses, and the cavernous sinuses. The low-risk CTV included bilateral cervical nodes not covered by the high- or intermediate-risk CTV (Fig. 1). Level IA and IB cervical nodal areas were not included in any CTV unless there was clinical evidence of involvement. The high-, intermediate-, and low-risk PTVs were created by 3 mm auto-expansion (except one patient with 2 mm auto-expansion) of the high-, intermediate-, and low-risk CTVs, respectively, and were restricted to the body. Doses of 67.5 Gy, 54-60 Gy, and 48 Gy in 30 daily fractions were applied to the high-, intermediate-, and low-risk PTVs, respectively.

Bottom Line: Weekly cisplatin was used as concurrent chemotherapy.Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity.However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated.

Materials and methods: Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy.

Results: With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients.

Conclusion: CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

No MeSH data available.


Related in: MedlinePlus