Incidence and dosimetric parameters for brainstem necrosis following intensity modulated radiation therapy in nasopharyngeal carcinoma

Li, Yang Chan; Chen, Fo Ping; Zhou, Guan Qun; Zhu, Jin Han; Hu, Jiang; Kang, De Hua; Wu, Cheng-Hsin; Lin, Li; Wang, Xiao Ju; Ma, Jingfei; Sun, Ying

doi:10.1016/j.oraloncology.2017.08.011

Cited by 14 publications

(17 citation statements)

References 24 publications

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“…The radiation technique has been reported previously. 3 The normal tissue constraints basically followed the Radiation Therapy Oncology Group protocols 0225 and 0615 11,12 and QUANTEC. For the brain stem, ideally we recommended a maximum dose of 54 Gy; if not fullfilled, the acceptable alternate was to allow <60 Gy to 1% of the volume of the brain stem.…”

Section: Treatment and Follow-upmentioning

confidence: 99%

“…2 In one study of 1544 patients with nasopharyngeal carcinoma (NPC) undergoing IMRT, only 2 developed BSI and, notably, in both patients the BSI showed remission on follow-up magnetic resonance imaging (MRI). 3 Thus, it appears that in the IMRT era, BSI might not be as serious a problem as before.…”

Section: Introductionmentioning

confidence: 95%

“…Such suggested maximum dose constraints could not be met in a number of cases in the study by Li et al, but the incidence of BSI was still very low. 3 It seems that the currently recommended dose constraint for the brain stem is relatively conservative and possibly results in compromised large-target coverage, thus leading to unnecessary target missing.…”

Section: Introductionmentioning

confidence: 99%

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Evolution and Dosimetric Analysis of Magnetic Resonance Imaging–Detected Brain Stem Injury After Intensity Modulated Radiation Therapy in Nasopharyngeal Carcinoma

Huang

Chen

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Evolution of brain stem injury (BSI) after intensity modulated radiation therapy and related dose constraints have not been well defined in a large cohort of nasopharyngeal carcinoma. Through longitudinal follow-up Purpose: To evaluate the evolution of radiation-induced brain stem injury (BSI) in patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy (IMRT) and to identify the critical dosimetric predictors of BSI. Methods and Materials: A total of 6288 NPC patients treated with IMRT between 2009 and 2015 were retrospectively reviewed. Among these 6288 patients, 24 had radiation-induced BSI, which manifested as edematous lesions and contrastenhanced lesions (CLs) on magnetic resonance imaging. Latency, symptoms, and evolution of BSI were assessed. Critical dosimetric predictors of BSI were identified using a penalized regression model with performance evaluated by receiver operating characteristic curve analysis.

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Section: Treatment and Follow-upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Evolution and Dosimetric Analysis of Magnetic Resonance Imaging–Detected Brain Stem Injury After Intensity Modulated Radiation Therapy in Nasopharyngeal Carcinoma

Huang

Chen

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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“…According to the findings from the Radiation Therapy Oncology Group (RTOG) trial (0225), the recommended maximal dose for IMRT should not exceed 54 Gy or 60 Gy for locally advanced NPC [21]. These thresholds were established based on dosimetry data from conventional two-dimensional and three-dimensional radiotherapy [9,22].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it is questionable whether such dose constraints are most effective in clinical practice, in terms of patient clinical outcome. Also, sometimes it is difficult for clinicians to achieve a satisfactory outcome under the restriction of an IMRT dose for stage T3–T4 NPC [7,10,22–26]. Currently, there are few reports regarding the study of brainstem radiation toxicity in patients treated for NPC [22].…”

Section: Introductionmentioning

confidence: 99%

High-Dose Static and Dynamic Intensity-Modulated Radiotherapy Combined with Chemotherapy for Patients with Locally Advanced Nasopharyngeal Carcinoma Improves Survival and Reduces Brainstem Toxicity

Sun

Chen²,

Xian-bin³

et al. 2018

Med Sci Monit

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BackgroundIntensity-modulated radiotherapy (IMRT) is the standard treatment for patients with nasopharyngeal cancer (NPC). However, the dose-volume criteria for adjacent anatomically normal organs at risk (OARs) remain controversial. The aim of this study was to evaluate the effects of higher than conventional doses of static and dynamic IMRT on the locoregional control of NPC, patient survival, and brainstem radiation toxicity.Material/MethodsPatients (n=186) with stage III and stage IVa NPC underwent high-dose static and dynamic IMRT treatment (68–76.96 Gy) with or without chemotherapy for 34–57 days. Overall survival (OS), the presence of distant metastases, and brainstem toxicity were assessed. One-year, three-year, and five-year follow-up was performed.ResultsHigh-dose IMRT alone or in combination with chemotherapy resulted in a 100% objective response rate and significantly improved OS rates, with one-year, three-year, and five-year OS rates of 94.1%, 89.8%, and 88.2%, respectively. The local recurrence rate (17.6%), and distant metastasis to the lung, liver, and bone (17.2%), and mortality (n=22) were reduced. Chemotherapy was the only factor that was significantly correlated with patient survival. Brainstem toxicity was reduced in patients treated with static IMRT (0.07%) and dynamic IMRT (0.08%). There were 26 additional factors that were not found to significantly affect brainstem toxicity.ConclusionsHigh-dose static or dynamic IMRT combined with chemotherapy improved survival and reduces distal metastasis with a very low occurrence of brainstem toxicity in patients with locally advanced NPC. These findings might provide therapeutic guidance for clinicians when planning optimal dose-volume IMRT parameters.

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Prioritizing sufficient dose to gross tumor volume over normal tissue sparing in intensity‐modulated radiotherapy treatment of T4 nasopharyngeal carcinoma

Chen

Zhang

et al. 2023

Head & Neck

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Background In intensity‐modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), priority is often given minimize dose to the critical organs at risk (OARs) to avoid potential morbid sequelae. However, in T4 NPC, dosimetric inadequacy enforced by dose constraints on OARs may significantly impact tumor control. Methods This was a single‐institute cohort that patients diagnosed between July 2005 and December 2010 with T4 NPC treated with IMRT. All patients were re‐classification according to the 7th‐AJCC stage. Results Overall, the average doses such as Dmax, D1%, D2% and D1cc for various Central nervous system (CNS) OARs including brainstem, optic nerve, chiasm, temporal lobes and spinal cord were found to exceed published guidelines as RTOG0225. However, no clinical toxicities were seen during the follow‐up period except for 13% patients with temporal lobe necrosis. Conclusion Our retrospective review showed that its feasible to maximize gross tumor volume dose coverage while exceeding most CNS OAR constraint standards, with ideal local control and no obvious increase of craniocerebral toxicity.

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Incidence and dosimetric parameters for brainstem necrosis following intensity modulated radiation therapy in nasopharyngeal carcinoma

Cited by 14 publications

References 24 publications

Evolution and Dosimetric Analysis of Magnetic Resonance Imaging–Detected Brain Stem Injury After Intensity Modulated Radiation Therapy in Nasopharyngeal Carcinoma

Evolution and Dosimetric Analysis of Magnetic Resonance Imaging–Detected Brain Stem Injury After Intensity Modulated Radiation Therapy in Nasopharyngeal Carcinoma

High-Dose Static and Dynamic Intensity-Modulated Radiotherapy Combined with Chemotherapy for Patients with Locally Advanced Nasopharyngeal Carcinoma Improves Survival and Reduces Brainstem Toxicity

Prioritizing sufficient dose to gross tumor volume over normal tissue sparing in intensity‐modulated radiotherapy treatment of T4 nasopharyngeal carcinoma

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