Comparison of the treatment outcomes of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma patients with parapharyngeal space extension

TANG, Ling; Chen, Lei; Mao, Yan Ping; Li, Wen Fei; Sun, Ying; Liu, Li Zhi; Lin, Ai Hua; Qiang, Hai; Shao, Jian Yong; Li, Li

doi:10.1016/j.radonc.2015.07.038

Cited by 16 publications

(8 citation statements)

References 19 publications

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“…Consistent with previous reports, 15,21 we found that the invasion of the parapharyngeal space or single/bilateral carotid sheath was associated with poor prognosis. Parapharyngeal space involvement is known to be closely associated with distant metastasis, 16,22,23 which would explain the poorer prognosis of these patients.…”

Section: Discussionsupporting

confidence: 92%

Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system

Cui

et al. 2020

Cancer Medicine

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Section: Discussionsupporting

confidence: 92%

Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system

Cui

et al. 2020

Cancer Medicine

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“…As a result, the 5-year OS of CCRT in LRANPC with IMRT was over 80%, and the local-regional control rate was over 90%. Additionally, the development of distant metastases also significantly decreased subsequently 30–32. Furthermore, a study reported that IMRT alone achieved a 5-year OS as high as 83.2%, which is similar to that for CCRT 33.…”

Section: Discussionmentioning

confidence: 61%

<p>Stage-specific concurrent chemoradiotherapy with or without induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a retrospective, population-based study</p>

Xia

et al. 2019

CMAR

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PurposeThis large population-based analysis aims to investigate whether the additional induction chemotherapy to concurrent chemoradiotherapy improved overall survival (OS) and disease-free survival (DFS) for locoregionally advanced nasopharyngeal carcinoma (LRANPC).Patients and MethodsThe study group comprised 3,980 patients who were treated either with IC+CCRT (1,888 patients) or CCRT alone (2,092 patients) between January 1998 and June 2013. Survival outcomes were compared using Cox proportional hazards regression models with adjustments for confounding provided by propensity score methods. Primary outcome variables included OS and DFS.ResultsKaplan–Meier analysis showed that CCRT and IC+CCRT were of similar benefit to OS (P=0.099), whereas there was a marginal benefit of CCRT to DFS (P=0.063) in the overall cohort, which showed no differences between the two treatment regimens using multivariate Cox analysis and propensity score. Interestingly, for patients with 2D radiationtherapy (2DRT), CCRT had OS and DFS benefits for stage III, with 5-year and 10-year OS for CCRT vs IC+CCRT being 88% and 75% vs 81% and 67%, respectively (P=0.002); 5-year and 10-year DFS for CCRT vs IC+CCRT being 84% and 74% vs 76% and 66%, respectively (P=0.002). In contrast, IC + CCRT had OS and DFS benefits for stage IVa-b, with 5-year and 10-year OS for CCRT vs IC+CCRT being 71% and 55% vs 76% and 60%, respectively (P=0.037, HR=0.786); 5-year and 10-year DFS for CCRT vs IC+CCRT were 64% and 50% vs 69% and 58%, respectively (P=0.038, HR=0.801). No difference was found in intensity-modulated radiotherapy (IMRT) subgroup.ConclusionOur study indicates that CCRT and IC+CCRT may have similar OS and DFS benefits for overall LRANPC. Stage-specific chemoradiotherapy may be administered based on the greatest benefit of IC+CCRT for stage IVa-b patients and CCRT alone for stage III patients received 2DRT. The optimal chemotherapy pattern in combination with IMRT needs further investigation.Trial registration ClinicalTrials.gov ID: NCT02604472

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“…Radiation therapy treatment planning for nasopharyngeal carcinoma (NPC) is often challenged by the convoluted target volume and many adjacent organs at risk (OAR) [1]. Intensity-modulated radiation therapy (IMRT) technique has been considered as a common treatment for NPC, because it delivers highly conformal doses to the targets and effectively spares the OARs, potentially improving the local control rate and reducing radiation-related toxicities [2]. However, it is time-consuming to manually generate an IMRT plan due to its intrinsic trial-and-error process.…”

Section: Introductionmentioning

confidence: 99%

A knowledge-based intensity-modulated radiation therapy treatment planning technique for locally advanced nasopharyngeal carcinoma radiotherapy

et al. 2020

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Background: To investigate the feasibility of a knowledge-based automated intensity-modulated radiation therapy (IMRT) planning technique for locally advanced nasopharyngeal carcinoma (NPC) radiotherapy. Methods: One hundred forty NPC patients treated with definitive radiation therapy with the step-and-shoot IMRT techniques were retrospectively selected and separated into a knowledge library (n = 115) and a test library (n = 25). For each patient in the knowledge library, the overlap volume histogram (OVH), target volume histogram (TVH) and dose objectives were extracted from the manually generated plan. 5-fold cross validation was performed to divide the patients in the knowledge library into 5 groups before validating one group by using the other 4 groups to train each neural network (NN) machine learning models. For patients in the test library, their OVH and TVH were then used by the trained models to predict a corresponding set of mean dose objectives, which were subsequently used to generate automated plans (APs) in Pinnacle planning system via an in-house developed automated scripting system. All APs were obtained after a single step of optimization. Manual plans (MPs) for the test patients were generated by an experienced medical physicist strictly following the established clinical protocols. The qualities of the APs and MPs were evaluated by an attending radiation oncologist. The dosimetric parameters for planning target volume (PTV) coverage and the organs-at-risk (OAR) sparing were also quantitatively measured and compared using Mann-Whitney U test and Bonferroni correction. Results: APs and MPs had the same rating for more than 80% of the patients (19 out of 25) in the test group. Both AP and MP achieved PTV coverage criteria for no less than 80% of the patients. For each OAR, the number of APs achieving its criterion was similar to that in the MPs. The AP approach improved planning efficiency by greatly reducing the planning duration to about 17% of the MP (9.85 ± 1.13 min vs. 57.10 ± 6.35 min).

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Comparison of the treatment outcomes of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma patients with parapharyngeal space extension

Cited by 16 publications

References 19 publications

Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system

Staging of T2 and T3 nasopharyngeal carcinoma: Proposed modifications for improving the current AJCC staging system

<p>Stage-specific concurrent chemoradiotherapy with or without induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a retrospective, population-based study</p>

A knowledge-based intensity-modulated radiation therapy treatment planning technique for locally advanced nasopharyngeal carcinoma radiotherapy

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