Dose Planning Study of Target Volume Coverage with Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience

Objective: To compare the 7th edition of the International Union Against Cancer (UICC) and the Chinese 2008 staging systems for nasopharyngeal carcinoma (NPC), and to provide evidence for further updates to these NPC staging systems.Methods: A retrospective analysis was carried out on 767 patients with newly diagnosed, pathologically confirmed non-metastatic NPC who were treated with intensity-modulated radiotherapy between 2006 and 2012. The prognostic value of the T category, N category, and clinical stage for the main survival outcomes of overall survival (OS), local relapse-free survival and distant metastasis-free survival were compared between the two staging systems. The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used to compare survival rates, and the Cox model was used for the multivariate prognostic analysis. Results:The T categories of the Chinese 2008 staging system had a significantly better prognostic value for OS and local relapse-free survival than those of the 7th edition of the UICC staging system. The N categories of both staging systems had a comparable prognostic value for OS and distant metastasis-free survival. The clinical stages of the 7th edition of the UICC staging system had a significantly better prognostic value for OS than those of the Chinese 2008 staging system. Based on these analyses, the T categories, N categories, and clinical stages of our proposed staging system had a significantly better prognostic value compared with the original staging system. Conclusions:The 7th edition of the UICC staging system and the Chinese 2008 staging system for NPC each has its own advantages with respect to prognostic prediction. The recommended staging system proposed in the present study could contribute to the next update of the current staging systems for NPC.

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Comparison of the 7th edition of the International Union Against Cancer and the Chinese 2008 staging systems for nasopharyngeal carcinoma and recommendations for future updates

Liang

Lei

Chen

et al. 2017

Precision Radiation Oncology

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Dosimetric Evaluation of a Simple Planning Technique for Improving Intensity-Modulated Radiotherapy for Nasopharyngeal Cancer

Cheung

et al. 2015

PLoS ONE

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PurposeTo evaluate the dosimetric outcomes of a simple planning technique for improving intensity-modulated radiotherapy (IMRT) for nasopharyngeal cancer (NPC).MethodsFor 39 NPC cases, generally acceptable original plans were generated and were improved by the two planning techniques, respectively: (1) a basal-dose-compensation (BDC) technique, in which the treatment plans were re-optimized based on the original plans; (2) a local-dose-control (LDC) technique, in which the original plans were re-optimized with constraints for hot and cold spots. The BDC, original, and LDC plans were then compared regarding homogeneity index (HI) and conformity index (CI) of planning target volumes (PTVs), organ-at-risk (OAR) sparing and monitor units (MUs) per fraction. The whole planning times were also compared between the BDC and LDC plans.ResultsThe BDC plans had superior HIs / CIs, by 13-24% / 3-243%, respectively, over the original plans. Compared to the LDC plans, the BDC plans provided better HIs only for PTVnx (the PTV of nasopharyngeal primary tumor) by 11% and better CIs for all PTVs by 2-134%. The BDC technique spared most OARs, by 1-9%. The average MUs of the BDC, original, and LDC plans were 2149, 2068 and 2179, respectively. The average whole planning times were 48 and 69 minutes for the BDC and LDC plans, respectively.ConclusionsFor the IMRT of nasopharyngeal cancer, the BDC planning technique can improve target dose homogeneity, conformity and OAR sparing, with better planning efficiency.

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Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

Liang¹,

Chen²,

Niu³

et al. 2016

PLoS ONE

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ObjectiveThe aim of this study was to compare the 2008 Chinese and the 7th edition of the American Joint Committee on Cancer (AJCC) staging systems for nasopharyngeal carcinoma and to provide proposals for updating T and N staging systems of the present staging system.MethodsBetween January 2007 and December 2012, a cohort of 752 patients with biopsy-proven, newly diagnosed, non-metastatic nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy were retrospectively analysed. Prognoses were compared by T stage, N stage, and clinical stage according to the two staging systems for overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS).ResultsIn terms of both the T and N staging systems, the two current staging systems were comparable in predicting OS. The T classification of the 2008 Chinese staging system was better in predicting LRFS, while the N classification of the 7th edition AJCC staging system was superior in predicting DMFS. In the modern era of intensity-modulated radiotherapy, the staging system should be updated by down-staging the current stage T2 to T1, and it might be rational to merge subcategories N1 and N2.ConclusionsThe two current staging systems each had advantages in predicting prognosis. It seems reasonable to downstage T2 to T1 and to merge N1 and N2.

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Dose Planning Study of Target Volume Coverage with Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Penang General Hospital Experience

Cited by 7 publications

References 15 publications

Comparison of the 7th edition of the International Union Against Cancer and the Chinese 2008 staging systems for nasopharyngeal carcinoma and recommendations for future updates

Comparison of the 7th edition of the International Union Against Cancer and the Chinese 2008 staging systems for nasopharyngeal carcinoma and recommendations for future updates

Dosimetric Evaluation of a Simple Planning Technique for Improving Intensity-Modulated Radiotherapy for Nasopharyngeal Cancer

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy

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