Top

Published in:

28-12-2023 | Radiotherapy | Original Article

Is a total dose of 54 Gy with radiochemotherapy sufficient for treatment of intermediate-risk volumes in nasopharyngeal cancer?

Authors: Dr. Meltem Dağdelen, Tuba Kurt Çatal, Songül Çavdar Karaçam, Emine Sedef Akovalı, Sevda Kanat, Halil Cumhur Yıldırım, Ömer Erol Uzel

Published in: Strahlentherapie und Onkologie | Issue 5/2024

Abstract

Background

The mainstay treatment of nasopharyngeal cancer (NPC) is radiation therapy (RT). The doses and volumes may differ from center to center. Most studies and guidelines recommend a total dose of 60 Gy for elective nodal and peritumoral volume treatment. This retrospective analysis aimed to analyze whether a dose reduction to 54 Gy to this volume would be associated with a higher risk of recurrence.

Methods

A total of 111 patients treated by intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy were retrospectively analyzed. The recurrent tumor volume was classified as “in field” if 95% of the recurrent volume was inside the 95% isodose, as “marginal” if 20–95% of the recurrence was inside the 95% isodose, or as “outside” if less than 20% of the recurrence was inside the 95% isodose.

Results

Median follow-up was 67 months (range 6–142). The 2‑ and 5‑year overall survival (OS) rates were 88.6% and 70%, respectively. The 2‑year locoregional control (LRC), disease-free survival (DFS), and distant metastasis-free survival (DMFS) were 93.3%, 89.3%, and 87.4%, and the 5‑year LRC, DFS, and DMFS were 86.8%, 74%, and 81.1%, respectively. Ten patients (9%) had a local and or regional recurrence. Half of the patients with locoregional failure had in-field recurrences. For primary tumor, there was no recurrence in the volume of 54 Gy. For regional lymph node volume, recurrence was detected in two (1.8%) patients in the volume of 54 Gy.

Conclusion

These retrospective data suggest that a dose reduction may be possible for intermediate-risk volumes, especially for the primary site.

Lee N et al (2007) Phase II multi-institutional study of IMRT±chemotherapy for nasopharyngeal carcinoma (RTOG 0225): Preliminary results. Int J Radiat Oncol Biol Phys 69(3):S13–S14. https://doi.org/10.1200/JCO.2008.19.9109CrossRef

Lee NY, Lu JJ, Yu Y (2013) Target volume delineation and field setup: a practical guide for conformal and intensity-modulated radiation therapy. SpringerCrossRef

Sze HC et al (2019) International Consensus on Delineation of Target Volumes and Organs at Risk, in Nasopharyngeal Carcinoma. Elsevier, pp 239–261

Lee N et al (2009) Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. JCO 27(22):3684. https://doi.org/10.1200/JCO.2008.19.9109CrossRef

Lee, N.Y., et al., Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. The lancet oncology, 2012. 13(2): p. 172–180. https://doi.org/10.1016/S1470–2045(11)70303‑5.

Guo Q et al (2021) Modified reduced-volume intensity-modulated radiation therapy in non-metastatic nasopharyngeal carcinoma: A prospective observation series. Radiother Oncol 156:251–257. https://doi.org/10.1016/j.radonc.2020.12.035CrossRefPubMed

Hong B et al (2013) Targeting tumor hypoxia in nasopharyngeal carcinoma. Head Neck 35(1):133–145. https://doi.org/10.1002/hed.21877CrossRefPubMed

Kong F et al (2014) Patterns of local-regional failure after primary intensity modulated radiotherapy for nasopharyngeal carcinoma. Radiat Oncol 9:1–7. https://doi.org/10.1186/1748-717X-9-60CrossRef

Hall EJ, Giaccia AJ (2006) Radiobiology for the Radiologist vol 6. Philadelphia

10.

Levine HL (1990) Functional endoscopic sinus surgery: evaluation, surgery, and follow-up of 250 patients. Laryngoscope 100(1):79–84. https://doi.org/10.1288/00005537-199001000-00016CrossRefPubMed

11.

Li J‑x et al (2014) Local failure patterns for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy. Radiat Oncol 9(1):1–8. https://doi.org/10.1186/1748-717X-9-87CrossRef

12.

Cao C et al (2018) Locoregional extension and patterns of failure for nasopharyngeal carcinoma with intracranial extension. Oral Oncol 79:27–32. https://doi.org/10.1016/j.oraloncology.2018.02.004CrossRefPubMed

13.

Ho FC et al (2012) Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: a meta-analysis of clinical evidence. Bmc Cancer 12:1–13. https://doi.org/10.1186/1471-2407-12-98CrossRef

14.

Du T et al (2019) The effectiveness of intensity-modulated radiation therapy versus 2D-RT for the treatment of nasopharyngeal carcinoma: A systematic review and meta-analysis. PLoS ONE 14(e0219611):7. https://doi.org/10.1371/journal.pone.0219611CrossRef

15.

Ng, W.T., et al., Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma. International Journal of Radiation Oncology* Biology* Physics, 2011. 79(2): p. 420–428. https://doi.org/10.1016/j.ijrobp.2009.11.024

16.

Chen AM et al (2012) Intensity-modulated radiotherapy for nasopharyngeal carcinoma: improvement of the therapeutic ratio with helical tomotherapy vs segmental multileaf collimator-based techniques. BJR 85(1016):e537–e543. https://doi.org/10.1259/bjr/23807619CrossRefPubMedPubMedCentral

17.

Chen W‑S et al (2016) Comparison of MRI, CT and 18F-FDG PET/CT in the diagnosis of local and metastatic of nasopharyngeal carcinomas: an updated meta analysis of clinical studies. Am J Transl Res 8(11):4532PubMedPubMedCentral

Title: Is a total dose of 54 Gy with radiochemotherapy sufficient for treatment of intermediate-risk volumes in nasopharyngeal cancer?
Authors: Dr. Meltem Dağdelen
Tuba Kurt Çatal
Songül Çavdar Karaçam
Emine Sedef Akovalı
Sevda Kanat
Halil Cumhur Yıldırım
Ömer Erol Uzel
Publication date: 28-12-2023
Publisher: Springer Berlin Heidelberg
Keyword: Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 5/2024
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-023-02186-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is a total dose of 54 Gy with radiochemotherapy sufficient for treatment of intermediate-risk volumes in nasopharyngeal cancer?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2024

Clinical outcomes and failure patterns after postoperative radiotherapy for oral cavity squamous cell carcinoma

Radiation therapy for cancer is potentially associated with reduced growth of concomitant abdominal aortic aneurysm

Stereotactic radiotherapy in the management of oligometastatic and recurrent head and neck cancer: a single-center experience

Can interventional radiotherapy (brachytherapy) be an alternative to surgery in early-stage oral cavity cancer? A systematic review

The impact of submandibular glands protection on xerostomia as monitored by diffusion-weighted imaging in nasopharyngeal carcinoma patients

Nintedanib zur Therapie der radiogenen Pneumonitis