Tumor Volume Reduction Rate during Adaptive Radiation Therapy as a Prognosticator for Nasopharyngeal Cancer
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose The purpose of this study is to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) for nasopharyngeal cancer (NPC). Materials and Methods We reviewed the RT records of 159 NPC patients treated with definitive RT with or without concurrent chemotherapy between January 2006 and February 2013. Adaptive re-planning was performed in all patients at the third week of RT. The pre- and mid-RT gross tumor volumes (GTVs) of the primary tumor and the metastatic lymph nodes were measured and analyzed for prognostic implications. Results After a median follow-up period of 41.5 months (range, 11.2 to 91.8 months) for survivors, there were 43 treatment failures. The overall survival and progression-free survival (PFS) rates at 5 years were 89.6% and 69.7%, respectively. The mean pre-RT GTV, mid-RT GTV, and TVRR were 45.9 cm3 (range, 1.5 to 185.3 cm3), 26.7 cm3 (1.0 to 113.8 cm3), and –41.9% (range, –87% to 78%), respectively. Patients without recurrence had higher TVRR than those with recurrence (44.3% in the no recurrence group vs. 34.0% in the recurrence group, p=0.004), and those with TVRR > 35% achieved a significantly higher rate of PFS at 5 years (79.2% in TVRR > 35% vs. 53.2% in TVRR ! 35%; p < 0.001). In multivariate analysis, TVRR was a significant factor affecting PFS (hazard ratio, 2.877; 95% confidence interval, 1.555 to 5.326; p=0.001). Conclusion TVRR proved to be a significant prognostic factor in NPC patients treated with definitive RT, and could be used as a potential indicator for early therapeutic modification during the RT course.
Abstract
Purpose The purpose of this study is to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) for nasopharyngeal cancer (NPC). Materials and Methods We reviewed the RT records of 159 NPC patients treated with definitive RT with or without concurrent chemotherapy between January 2006 and February 2013. Adaptive re-planning was performed in all patients at the third week of RT. The pre- and mid-RT gross tumor volumes (GTVs) of the primary tumor and the metastatic lymph nodes were measured and analyzed for prognostic implications. Results After a median follow-up period of 41.5 months (range, 11.2 to 91.8 months) for survivors, there were 43 treatment failures. The overall survival and progression-free survival (PFS) rates at 5 years were 89.6% and 69.7%, respectively. The mean pre-RT GTV, mid-RT GTV, and TVRR were 45.9 cm3 (range, 1.5 to 185.3 cm3), 26.7 cm3 (1.0 to 113.8 cm3), and –41.9% (range, –87% to 78%), respectively. Patients without recurrence had higher TVRR than those with recurrence (44.3% in the no recurrence group vs. 34.0% in the recurrence group, p=0.004), and those with TVRR > 35% achieved a significantly higher rate of PFS at 5 years (79.2% in TVRR > 35% vs. 53.2% in TVRR ! 35%; p < 0.001). In multivariate analysis, TVRR was a significant factor affecting PFS (hazard ratio, 2.877; 95% confidence interval, 1.555 to 5.326; p=0.001). Conclusion TVRR proved to be a significant prognostic factor in NPC patients treated with definitive RT, and could be used as a potential indicator for early therapeutic modification during the RT course.
참고문헌 (24)
- Edge SB, "AJCC cancer staging manual" (2009), Springer
- Ball DL, "Stage is not a reliable indicator of tumor volume in non-small cell lung cancer : a preliminary analysis of the Trans-Tasman Radiation Oncology Group 99-05 database", J Thorac Oncol, 1, pp.667~672 (2006)
- Chen MK, "Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary tumor volume", Cancer, 100, pp.2160~2166 (2004)
- Chua DT, "Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome", Int J Radiat Oncol Biol Phys, 39, pp.711~719 (1997)
- Lok BH, "Intensity-modulated radiation therapy in oropharyngeal carcinoma : effect of tumor volume on clinical outcomes", Int J Radiat Oncol Biol Phys, 82, pp.1851~1857 (2012)
- Wang JZ, "Sequential magnetic resonance imaging of cervical cancer : the predictive value of absolute tumor volume and regression ratio measured before, during, and after radiation therapy", Cancer, 116, pp.5093~5101 (2010)
- Nam H, "The prognostic significance of tumor volume regression during radiotherapy and concurrent chemoradiotherapy for cervical cancer using MRI", Gynecol Oncol, 107, pp.320~325 (2007)
- Lee H, "Tumor volume reduction rate measured during adaptive definitive radiation therapy as a potential prognosticator of locoregional control in patients with oropharyngeal cancer", Head Neck, 36, pp.499~504 (2014)
- Hoeben BA, "18F-FLT PET during radiotherapy or chemoradiotherapy in head and neck squamous cell carcinoma is an early predictor of outcome", J Nucl Med, 54, pp.532~540 (2013)
- Yeo SG, "Tumor volume reduction rate after preoperative chemoradiotherapy as a prognostic factor in locally advanced rectal cancer", Int J Radiat Oncol Biol Phys, 82, pp.193~199 (2012)
- Yang SN, "Clinical implications of the tumor volume reduction rate in head-and-neck cancer during definitive intensity-modulated radiotherapy for organ preservation", Int J Radiat Oncol Biol Phys, 79, pp.1096~1103 (2011)
- Mancuso AA, "Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma", J Clin Oncol, 17, pp.631~637 (1999)
- Pameijer FA, "Evaluation of pretreatment computed tomography as a predictor of local control in T1", T2pyriform sinus carcinoma treated with definitive radiotherapy, 1998, pp.20, 159~168
- Barker JL Jr, "Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-and-neck cancer using an integrated CT", linear accelerator system, 2004, pp.59, 960~970
- Castadot P, "Assessment by a deformable registration method of the volumetric and positional changes of target volumes and organs at risk in pharyngo-laryngeal tumors treated with concomitant chemo-radiation", Radiother Oncol, 95, pp.209~217 (2010)
- Hansen EK, "Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer", Int J Radiat Oncol Biol Phys, 64, pp.355~362 (2006)
- Bhide SA, "Weekly volume and dosimetric changes during chemoradiotherapy with intensity-modulated radiation therapy for head and neck cancer : a prospective observational study", Int J Radiat Oncol Biol Phys, 76, pp.1360~1368 (2010)
- Wang W, "Clinical study of the necessity of replanning before the 25th fraction during the course of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma", Int J Radiat Oncol Biol Phys, 77, pp.617~621 (2010)
- Zhao L, "The role of replanning in fractionated intensity modulated radiotherapy for nasopharyngeal carcinoma", Radiother Oncol, 98, pp.23~27 (2011)
- Yang H, "Replanning during intensity modulated radiation therapy improved quality of life in patients with nasopharyngeal carcinoma", Int J Radiat Oncol Biol Phys, 85, pp.47~54 (2013)
- Bosmans G, "Intra-patient variability of tumor volume and tumor motion during conventionally fractionated radiotherapy for locally advanced non-small-cell lung cancer : a prospective clinical study", Int J Radiat Oncol Biol Phys, 66, pp.748~753 (2006)
- Britton KR, "Assessment of gross tumor volume regression and motion changes during radiotherapy for non-small-cell lung cancer as measured by four-dimensional computed tomography", Int J Radiat Oncol Biol Phys, 68, pp.1036~1046 (2007)
- Chan AT, "Phase II study of neoadjuvant carboplatin and paclitaxel followed by radiotherapy and concurrent cisplatin in patients with locoregionally advanced nasopharyngeal carcinoma : therapeutic monitoring with plasma Epstein-Barr virus DNA", J Clin Oncol, 22, pp.3053~3060 (2004)
- Lin JC, "Detection of Epstein-Barr virus DNA in the peripheral-blood cells of patients with nasopharyngeal carcinoma : relationship to distant metastasis and survival", J Clin Oncol, 19, pp.2607~2615 (2001)