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Feasibility of Selective Neck Irradiation with Lower Elective Radiation Dose in Treating Nasopharynx Cancer Patients

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Purpose This study aimed to report the clinical outcomes following selective neck irradiation (SNI) with lower elective radiation therapy (RT) dose in treating nasopharyngeal cancer (NPC) patients. Materials and Methods A total of 347 NPC patients received definitive RT according to our SNI policy and were retrospectively analyzed. The clinical target volumes (CTVs) were subdivided into CTV at high risk (CTV-HR) and CTV at low risk (CTV-LR). The typical doses to gross tumor volume (GTV), CTV-HR, and CTV-LR were 68.4-70.0 Gy, 54.0-60.0 Gy, and 36.0 Gy. Results With the median follow-up of 68.1 months (range, 2.3 to 197.1 months), the 5-year rates of loco-regional control and progression-free survival in all the patients were 85.0% and 70.8%, respectively. Thirty patients developed regional failure and the regional control rates at 3 and 5 years were 92.6% and 91.4%, respectively. The sites of regional failure in relation to the target volume were exclusively inside GTV/CTV-HR in 20, inside and outside GTV/CTVHR in three, and exclusively outside GTV/CTV-HR in seven, which were 5.7%, 0.9%, and 2.0% of total patients, respectively. Conclusion The clinical outcomes by the current SNI policy were feasible and comparable to those following classic elective nodal irradiation policy.

Abstract

Purpose This study aimed to report the clinical outcomes following selective neck irradiation (SNI) with lower elective radiation therapy (RT) dose in treating nasopharyngeal cancer (NPC) patients. Materials and Methods A total of 347 NPC patients received definitive RT according to our SNI policy and were retrospectively analyzed. The clinical target volumes (CTVs) were subdivided into CTV at high risk (CTV-HR) and CTV at low risk (CTV-LR). The typical doses to gross tumor volume (GTV), CTV-HR, and CTV-LR were 68.4-70.0 Gy, 54.0-60.0 Gy, and 36.0 Gy. Results With the median follow-up of 68.1 months (range, 2.3 to 197.1 months), the 5-year rates of loco-regional control and progression-free survival in all the patients were 85.0% and 70.8%, respectively. Thirty patients developed regional failure and the regional control rates at 3 and 5 years were 92.6% and 91.4%, respectively. The sites of regional failure in relation to the target volume were exclusively inside GTV/CTV-HR in 20, inside and outside GTV/CTVHR in three, and exclusively outside GTV/CTV-HR in seven, which were 5.7%, 0.9%, and 2.0% of total patients, respectively. Conclusion The clinical outcomes by the current SNI policy were feasible and comparable to those following classic elective nodal irradiation policy.

참고문헌 (30)

  1. Lee AW, "Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma", J Natl Cancer Inst, 102, pp.1188~1198 (2010)
  2. Ou SH, "Epidemiology of nasopharyngeal carcinoma in the United States : improved survival of Chinese patients within the keratinizing squamous cell carcinoma histology", Ann Oncol, 18, pp.29~35 (2007)
  3. Ho FC, "Patterns of regional lymph node metastasis of nasopharyngeal carcinoma : a meta-analysis of clinical evidence", BMC Cancer, 12, pp.98~ (2012)
  4. Lee AW, "Treatment of stage I nasopharyngeal carcinoma : analysis of the patterns of relapse and the results of withholding elective neck irradiation", Int J Radiat Oncol Biol Phys, 17, pp.1183~1190 (1989)
  5. Fletcher GH, "Elective irradiation of subclinical disease in cancers of the head and neck", Cancer, 29, pp.1450~1454 (1972)
  6. Edge SB, "AJCC cancer staging handbook: from the AJCC cancer staging manual" (2011), Springer
  7. Jeong Y, "Lymph node standardized uptake values at pre-treatment(18)F-fluorodeoxyglucose positron emission tomography as a valuable prognostic factor for distant metastasis in nasopharyngeal carcinoma", Br J Radiol, 90, pp.20160239~ (2017)
  8. Hoang JK, "Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach", AJR Am J Roentgenol, 200, pp.W17~W25 (2013)
  9. Lee NY, "Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma(RTOG 0615) : a phase 2 multi-institutional trial", Lancet Oncol, 13, pp.172~180 (2012)
  10. Zhang F, "Investigation of the feasibility of elective irradiation to neck level Ib using intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma : a retrospective analysis", BMC Cancer, 15, pp.709~ (2015)
  11. Chen JZ, "Results of a phase 2 study examining the effects of omitting elective neck irradiation to nodal levels IV and Vb in patients with N(0-1)nasopharyngeal carcinoma", Int J Radiat Oncol Biol Phys, 85, pp.929~934 (2013)
  12. Gao Y, "Is elective irradiation to the lower neck necessary for N0 nasopharyngeal carcinoma?", Int J Radiat Oncol Biol Phys, 77, pp.1397~1402 (2010)
  13. Lee AW, "International guideline for the delineation of the clinical target volumes(CTV)for nasopharyngeal carcinoma", Radiother Oncol, 126, pp.25~36 (2018)
  14. Withers HR, "Dose-response relationship for radiation therapy of subclinical disease", Int J Radiat Oncol Biol Phys, 31, pp.353~359 (1995)
  15. van den Bosch S, "Patterns of recurrence in electively irradiated lymph node regions after definitive accelerated intensity modulated radiation therapy for head and neck squamous cell carcinoma", Int J Radiat Oncol Biol Phys, 94, pp.766~774 (2016)
  16. van den Bosch S, "Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer : radiotherapy target volume transformation and dose de-escalation", Radiother Oncol, 128, pp.472~478 (2018)
  17. Gunderson LL, "Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma : survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil", mitomycin versus fluorouracil, J Clin Oncol, pp.2012, 30[DOI]
  18. Bedi M, "Elective lymph node irradiation with intensity-modulated radiotherapy: is conventional dose fractionation necessary?", Int J Radiat Oncol Biol Phys, 83, pp.e87~e92 (2012)
  19. Salama JK, "Induction chemotherapy and concurrent chemoradiotherapy for locoregionally advanced head and neck cancer : a multi-institutional phase II trial investigating three radiotherapy dose levels", Ann Oncol, 19, pp.1787~1794 (2008)
  20. Nevens D, "Reduction of the dose of radiotherapy to the elective neck in head and neck squamous cell carcinoma; a randomized clinical trial. Effect on late toxicity and tumor control", Radiother Oncol, 122, pp.171~177 (2017)
  21. Kong F, "Patterns of local-regional failure after primary intensity modulated radiotherapy for nasopharyngeal carcinoma", Radiat Oncol, 9, pp.60~ (2014)
  22. Wolden SL, "Intensity-modulated radiation therapy(IMRT)for nasopharynx cancer : update of the Memorial Sloan-Kettering experience", Int J Radiat Oncol Biol Phys, 64, pp.57~62 (2006)
  23. Wong FC, "Whole-field simultaneous integrated-boost intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma", Int J Radiat Oncol Biol Phys, 76, pp.138~145 (2010)
  24. Wang R, "Definitive intensity-modulated radiation therapy for nasopharyngeal carcinoma : long-term outcome of a multicenter prospective study", J Cancer Res Clin Oncol, 139, pp.139~145 (2013)
  25. Au KH, "Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy(IMRT)in Hong Kong : a report of 3328 patients(HKNPCSG 1301 study)", Oral Oncol, 77, pp.16~21 (2018)
  26. Pow EH, "Can intensitymodulated radiotherapy preserve oral health-related quality of life of nasopharyngeal carcinoma patients?", Int J Radiat Oncol Biol Phys, 83, pp.e213~e221 (2012)
  27. Yang H, "Treatment outcomes after reduction of the target volume of intensity-modulated radiotherapy following induction chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma : a prospective, multi-center, randomized clinical trial", Radiother Oncol, 126, pp.37~42 (2018)
  28. Hawkins PG, "Sparing all salivary glands with IMRT for head and neck cancer : longitudinal study of patient-reported xerostomia and head-and-neck quality of life", Radiother Oncol, 126, pp.68~74 (2018)
  29. Nuyts S, "Reduction of the dose to the elective neck in head and neck squamous cell carcinoma, a randomized clinical trial using intensity modulated radiotherapy(IMRT) : dosimetrical analysis and effect on acute toxicity", Radiother Oncol, 109, pp.323~329 (2013)
  30. Maguire PD, "Single-arm phase 2 trial of elective nodal dose reduction for patients with locoregionally advanced squamous cell carcinoma of the head and neck", Int J Radiat Oncol Biol Phys, 100, pp.1210~1216 (2018)

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