Abstract
BackgroundThe definition of clinical target volume (CTV) in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) has not been addressed. We performed this study to assess the feasibility and efficacy of using IMRT with reduced-volume CTV for the treatment of nasopharyngeal carcinoma.MethodsWe retrospectively reviewed 293 non-metastatic NPC patients treated with IMRT from 2002 to 2013. A total of 180 matched cases finally included with 90 received conventional-volume IMRT (CV-IMRT) and 90 received reduced-volume IMRT (RV-IMRT). Kaplan-Meier method and log-rank tests were used to compare NPC-specific survival. Multivariate analyses using the Cox proportional hazards model were conducted to detect independent predictors.ResultsWith a median follow-up of 70 months, the 3-year overall survival, progression-free survival, distant metastasis-free survival, local recurrence-free survival, regional recurrence-free survival, locoregional recurrence-free survival rates were 88.9, 84.4, 92.2, 91.1, 98.9, 91.1% for the CV-IMRT arm and 92.2, 85.6, 90.0, 93.3, 98.9, 93.3% for the RV-IMRT arm, respectively. None significant survival difference was observed. Additionally, RV-IMRT was associated with reduced risk of late xerostomia (P = 0.039) and hearing loss (P = 0.008), compared versus CV-IMRT.ConclusionsThe use of RV-IMRT for the treatment of NPC led to comparable survival condition and truly reduced toxicity reactions compared versus CV-IMRT.
Highlights
The definition of clinical target volume (CTV) in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) has not been addressed
The Radiation Therapy Oncology Group (RTOG) trials involving IMRT of NPC put forward the delineation of CTV [11, 12], which were largely based on our previous experience in twodimensional radiotherapy (2D-RT)
Radiotherapy Between December 2002 and December 2009, the first 122 NPC patients were treated with IMRT and the target volumes were delineated by taking RTOG protocol as the reference [11], which was regarded as the conventional-volume IMRT (CV-IMRT) group
Summary
The definition of clinical target volume (CTV) in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) has not been addressed. The locoregional control of NPC depends on high-dose radiotherapy, whereas the adjacent critical, dose-limiting normal structures are inevitably exposed to rays. Intensity modulated radiation therapy (IMRT), a way of breaking through in the treatment of NPC, offering significant advantages in target dose uniformity and the sparing of adjacent organs at risk, causing a more satisfactory disease control and a lower rate of toxicity than traditional radiotherapy [4,5,6]. The Radiation Therapy Oncology Group (RTOG) trials involving IMRT of NPC put forward the delineation of CTV [11, 12], which were largely based on our previous experience in twodimensional radiotherapy (2D-RT). According to the previous research results, locoregional recurrence has become a main failure mode and the majority occurs
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