Efficacy Of Intensity-modulated Radiotherapy Research Articles

Clinical Efficacy and Complications of Intensity-modulated Radiation Therapy in Patients With Oropharyngeal Carcinoma: Especially Focus On Osteoradionecrosis

We explored the relative clinical efficacy of intensity-modulated radiation therapy (IMRT) in patients with oropharyngeal cancer (OPC) compared with three-dimensional conformal radiation therapy (3D-CRT). Seventy-four OPC patients treated with definitive IMRT or 3D-CRT between May 2010 and December 2018 were analyzed. Of these, 42 patients were treated with IMRT and 32 with 3D-CRT. We compared clinical benefits and complications. Particular attention was focused on osteoradionecrosis (ORN), which is the most problematic radiation late adverse event, and evaluated the irradiated mandibular volumes. There was no significant difference in the 3-year overall survival (OS), progression free survival (PFS) and locoregional control (LRC) rates between the two groups. However, late Grade 2 xerostomia was lower in the IMRT groups. Four patients (19.0%) developed Grade 3, while no patients developed ORN in the IMRT group (P = 0.003). A comparison of the mandible volumes between the two groups showed that the IMRT group had lower mandibular volumes than the 3D-CRT group in the high-dose range of V40, V50, V60 and V70. In addition, a comparison of the mandibular volumes between ORN and non-ORN showed a significant difference in the V60 and V70. ORN incidence was higher in V60 ≥ 25% and V70 ≥ 15%. A comparison of IMRT and 3D-CRT showed no significant difference in outcomes, however, IMRT led to a significant reduction in late xerostomia and ORN in OPC patients. Reducing of the mandibular V60 and V70 by IMRT seemed to reduce the risk of ORN.

Treatment Outcomes of Concurrent Nimotuzumab with Intensity Modulated Radiotherapy in Advanced Nasopharyngeal Carcinoma Patients Unfit for Concurrent Chemoradiotherapy: A Single Institute Experience

To assess the safety and efficacy of intensity-modulated radiotherapy (IMRT) combined with nimotuzumab for patients with locally advanced nasopharyngeal carcinoma (LA-NPC) medically unfit to receive concomitant chemotherapy. From 2016.6 to 2020.9, 34 newly diagnosed patients with local-regional advanced NPC medically unfit for concurrent chemoradiation had undergone definitive radiotherapy and were retrospectively evaluated. All patients were treated with IMRT combined treatment modality of nimotuzumab with or without cisplatin-based induction chemotherapy. Nimotuzumab was administered concurrently with IMRT at a weekly dose of 200 mg. Acute and late radiation-related toxicities were evaluated based on the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 during and after IMRT. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate prognostic analyses were performed by using the Cox proportional hazard model. The median follow-up time for the entire group was 15 months (range 5 to 55 months). At the time of this analysis, a total of 2 cases developed loco-regional recurrence. In addition, 4 patients developed distant metastasis. There was a total of 5 deaths: 3 patients died from distant metastasis, 1 patient died from the progression of loco-regional disease after recurrence, and the causes of death for the additional 1 case was a nasopharyngeal ulcer and deadly bleeding. The 1-year OS rate of the whole cohort was 87.9%, and the 1-year LFFR, DFFR, and PFS rates were 100%, 91.0%, and 91.0%, respectively. During the period of concurrent nimotuzumab and IMRT, no grade 3-4 hematologic toxicities and dermatitis were observed. Grade 3-4 radiotherapy-related oral mucositis was reported in 7 patients (20.6%). No infusion reaction was observed. No acneiform eruptions were found among these patients. The most commonly observed late complication was xerostomia. The degree of dry mouth in most patients was mild-to-moderate at the time of the last follow-up. Finally, 7 patients developed either unilateral or bilateral hearing impairment. One female patient experienced a nasopharyngeal ulcer and deadly bleeding after 5 months of completion of radiotherapy. Concurrent nimotuzumab with IMRT for the treatment of LA-NPC was well tolerated, with encouraging survival data, and it could be an effective treatment alternative for patients with LA-NPC medically unfit for concomitant chemotherapy. Further clinical trials are needed to confirm these findings.

Intensity-modulated radiation therapy for prostate cancer after rectal surgery: a single hospital long-term safety analysis.

Radiotherapy is a treatment option for prostate cancer patients after rectal surgery; however, the toxicity profile of radiotherapy for such patients has not been elucidated. This study aimed to evaluate the long-term toxicities and efficacy of intensity-modulated radiotherapy (IMRT) in patients with prostate cancer who had undergone rectal surgery. We retrospectively analyzed patients with prostate cancer after rectal surgery, who were definitively treated with IMRT between January 2000 and December 2019 at our institution. The planned total dose was 70-78Gy in 2-Gy fraction, and the dose to the rectal anastomosis was limited to 70Gy. The acute and late toxicities and survival outcomes were evaluated. Twenty patients were included in the analysis. The median age was 71years, with a median follow-up of 86months. The median time from surgery to IMRT was 93.5months. The median prostate-specific antigen value was 13.17ng/ml. The median total dose was 74Gy, and the median maximum dose to rectal anastomosis was 66.97Gy. The 8-year biochemical recurrence-free and overall survival rates were 70.2% and 90.0%, respectively. The incidence rates of grade 2 acute genitourinary and gastrointestinal toxicities were 14.3% and 0%, respectively. No grade ≥ 3 acute or late toxicities were observed when the rectal anastomosis dose was limited to 70Gy. This retrospective analysis suggested that IMRT for patients with prostate cancer after rectal surgery may be safe and effective with rectal dose constraint of Dmax < 70Gy if more than 5years have passed after surgery.

Intensity-modulated radiation therapy for nasal cavity and paranasal sinus tumors: Experience from a single institute.

To assess the efficacy of intensity-modulated radiation therapy (IMRT) for tumors of the nasal cavity and paranasal sinus (PNS) region. Two hundred fourteen patients with tumors of the nasal cavity and PNS region treated with curative intent IMRT between 2007 and 2019 were included in this retrospective analysis. Fifty-one (24.1%) received definitive RT/CTRT and 163 (75.9%) received adjuvant RT. Most common histology was squamous cell carcinoma (26.1%) followed by adenoid cystic carcinoma (21.5%). The median follow-up was 43.5months. The 5-year local control (LC), event-free survival (EFS), and overall survival (OS) for the entire cohort was 66.9%, 59%, and 73.9%, respectively. On univariate analysis treatment with nonsurgical modality, T classification and undifferentiated/poorly differentiated histology were associated with inferior 5-year LC, EFS, and OS. Four patients had late Grade 3/Grade 4 ocular toxicity. IMRT should be the standard of care for tumors of PNS region across all histologies and treatment setting.

Long-Term Toxicity and Efficacy of Intensity-Modulated Radiation Therapy in Cervical Cancers: Experience of a Cancer Hospital in Pakistan.

PURPOSETo report the chronic toxicity and disease outcomes attributable to intensity-modulated radiation therapy (IMRT) in patients with cervical cancer.METHODS AND MATERIALSBetween January 2014 and December 2018, a retrospective review of medical records of patients with cervical cancer who received radiation therapy with IMRT was performed. Disease and treatment-related details were documented. Follow-up notes were reviewed, and severity of late toxicities was recorded. Overall survival (OS) and disease-free survival (DFS) at 3 years were estimated.RESULTSA total of 222 patients’ records were reviewed. Mean age was 50.7 years. Median follow-up duration was 33 months (range, 2-70 months). The most common toxicity was vaginal stricture (grade 2, n = 59, 26.6%; grade 3, n = 4, 1.80%), followed by proctitis (grade 2, n = 24; 10.8%; grade 3, n = 7; 3.20%). Seven patients (grade 2, n = 5, 2.3%; grade 3, n = 2; 0.90%) developed cystitis, and only 5 (grade 2; 2.3%) were found to have colitis. None of the patients had grade 4 or grade 5 toxicities. There was a significant difference in late complications in patients with nodal disease or those who underwent prior surgery (P < .05). Three-year OS and DFS rates were 79.7% and 81.9%, respectively. Patients with tumor size > 5 cm and those with pelvic lymph node metastasis had poor survival rates (P < .05).CONCLUSIONIMRT is an effective and well-tolerated technique that should be considered in patients with lymph node disease and in postoperative patients. There is an inverse relationship between tumor size and nodal involvement with respect to OS and DFS.

Postoperative radiotherapy with intensity-modulated radiation therapy versus 3-dimensional conformal radiotherapy in early breast cancer: A randomized clinical trial of KROG 15-03

PurposeTo investigate the safety and efficacy of intensity-modulated radiation therapy (IMRT) for early breast cancer compared with 3-dimensional conformal radiotherapy (3D-CRT) in a prospective and randomized trial. Methods and materialsFrom March 2015 to February 2018, 693 patients with pT1-2N0M0 early breast cancer who underwent breast-conserving surgery were enrolled and randomly assigned into IMRT and 3D-CRT. The primary endpoint was 3-year locoregional recurrence-free survival (LRRFS). The secondary endpoints were recurrence-free survival, overall survival, acute toxicity, target coverage index, irradiation dose to organs at risk, and fatigue inventory. The radiation dose for the 3D-CRT arm was 59.4 Gy in 33 fractions for 6.5 weeks. It was 57.4 Gy in 28 fractions with simultaneous integrated boost for 5.5 weeks for the IMRT arm. ResultsOf 693 patients, 349 and 344 patients received 3D-CRT and IMRT, respectively. There was no significant difference in LRRFS between the two arms. Conformity index of planning target volume was significantly superior in the IMRT arm than the 3D-CRT arm (p < 0.001). The mean lung dose and V5-V50 for the ipsilateral lung were significantly lower in the IMRT arm than the 3D-CRT arm (all p < 0.05). The incidence of grade 2 or higher dermatitis was significantly lower in the IMRT arm (p = 0.009). ConclusionCompared to 3D-CRT, IMRT showed similar results in locoregional tumor control but superior results in planning target volume coverage. When IMRT is used in breast cancer, the irradiation dose to an ipsilateral lung and skin toxicity can be reduced.

Efficacy of intensity-modulated radiation therapy for optic nerve sheath meningioma

PurposeThe present study examined the efficacy and complications associated with intensity-modulated radiation therapy (IMRT) for optic nerve sheath meningioma (ONSM) in 15 cases and compared visual function before and after treatment.MethodsConsecutively diagnosed patients with ONSM treated with IMRT were evaluated from 2012 to 2017. We categorized ONSM with three growth patterns (diffuse, fusiform, or globular). Visual acuity, visual fields, and optic disc findings were assessed before and after IMRT. Ocular and systemic complications were evaluated during and after treatment.ResultsThe 15 patients selected for analysis ranged in age from 33 to 77 years. Post-treatment observation periods were 8 to 57 months. After IMRT, tumor enlargement was not detected in any eyes, and tumor reduction was seen in 2 eyes. At final post-treatment follow-up, eyes with fusiform and globular growth maintained better visual acuity compared with pre-treatment, whereas 2 of 5 eyes with diffuse growth showed reduced vision. Five eyes with no apparent optic disc abnormality maintained better visual acuity compared with pre-treatment, whereas 8 of 10 eyes with disc edema and atrophy remained stable or showed reduced vision. Improvements were seen in all 5 eyes with optic discs negative for pre-treatment abnormalities. Final post-treatment visual field abnormalities improved in 11 eyes. All adverse events identified during IMRT improved rapidly during the treatment period.ConclusionIMRT for the treatment of ONSM achieved improvement and preserved visual function. In particular, early treatment with IMRT before the appearance of optic disc abnormalities can be more effective for improving visual function.

调强放疗治疗TACE后复发或残留PHC的疗效评价

调强放疗治疗TACE后复发或残留PHC的疗效评价

Clinical efficacy of intensity-modulated radiotherapy in treatment of 66 patients with intermediate risk localized prostate cancer

Objective To evaluate the clinical efficacy and adverse events of intensity-modulated radiotherapy (IMRT) in the treatment of intermediate risk localized prostate cancer, and analyze the significance of prostate-specific antigen (PSA) level changes. Methods Clinical data of 66 patients with intermediate risk localized prostate cancer admitted to our hospital between 2007 and 2018 were retrospectively analyzed. Sixty patients were treated with endocrine therapy before radiotherapy. The radiation field covered the pelvic lymph node drainage area in 6 cases. Forty-seven patients received image-guided radiotherapy (IGRT). The median dose in the prostate and seminal vesicle was 78 Gy and 48 Gy in the pelvic lymph node drainage area. The survival rate was calculated using the Kaplan-Meier method. Results The median age was 77 years. The median follow-up time was 71.3 months. The 5-year sample size was 47. The 3-and 5-year overall survival (OS) was 98% and 90%.The 3-and 5-year cancer-specific survival (CSS) was 100% and 93%.The 3-and 5-year biochemical relapse-free survival was 97% and 86%.The mean time of PSA declining to the nadir was 5.83 months. The median level of PSA nadir was 0.06 ng/ml after IMRT. The incidence of grade I and Ⅱ early adverse events in the urinary system was 38% and 6%. The incidence of grade I and Ⅱ early adverse events in the gastrointestinal system was 21% and 3%. The incidence of grade I and Ⅱ advanced-stage adverse events in the urinary system was 9% and 2%. The incidence of grade I advanced-stage adverse events in the gastrointestinal system was 5%. Conclusions IMRT yields high clinical efficacy in the treatment of intermediate risk localized prostate cancer with a low risk of adverse events in the early and advanced stage. The monitoring of PSA after IMRT contributes to the assessment of clinical prognosis. Key words: Prostate neoplasm/radiotherapy; Treatment outcome; Prostate-specific antigen

Clinical study of intensity-modulated radiation therapy combined with chemotherapy in advanced cervical cancer

Objective To explore the clinical efficacy of intensity-modulated radiotherapy combined with chemotherapy in the treatment of advanced cervical cancer. Methods All 121 patients with advanced cervical cancer (stage ⅡB & ⅢA & ⅢB) selected in our hospital from June 2012 to June 2014, who were treated with combined chemoradiotherapy, were divided into observation group [intensity modulated radiation therapy (IMRT)group)] and control group [3-dimensional conformal radiation therapy (3D-CRT) group]. There was no significant difference between two groups in mean age, body mass index, International Federation of Gynecology and Obstetrics (FIGO) clinical stage, pathological type and chemotherapy mode (P>0.05). The clinical features of two groups were compared. The treatment and follow-up of two groups were recorded. Results The bone marrow suppression [32.2%(19/59) vs 51.6%(32/62)], gastrointestinal reaction [42.4%(25/59) vs 62.9%(39/62)], and rectal reaction rate [27.1%(16/59) vs 45.2%(28/62)] of the observation group were significantly less than that of the control group (P 0.05). Two groups were followed up for 3 years, the local control rate of the observation group was significantly higher than that of the control group (86.3% vs 70.1%) (P<0.05). Conclusions IMRT combined with chemotherapy in the treatment of advanced cervical cancer can improve the local control rate of tumor, protect the endangered organ, and reduce the side effects of radiotherapy. Key words: Uterine cervical neoplasms/DT/RT; Cisplatin/AD; Radiotherapy, intensity-modulated; Combined modality therapy

Efficacy and survival rate of intensity-modulated radiotherapy combined with chemotherapy for elderly patients with locally advanced oropharyngeal cancer.

The efficacy of intensity-modulated radiotherapy (IMRT) combined with chemotherapy in the treatment of elderly patients with locally advanced oropharyngeal cancer and its effect on survival rate were studied. Elderly patients (n=150) diagnosed with locally advanced oropharyngeal cancer by histopathology were selected and randomly divided into the observation group (n=75) and the control group (n=75). Patients in the observation group were treated with IMRT combined with chemotherapy, while those in the control group were treated with conventional radiotherapy and chemotherapy. The two groups were treated with docetaxel + cisplatin (TP regimen). All patients received 1 to 2 cycles of docetaxel + cisplatin-induced chemotherapy, and after the radiotherapy began, the chemotherapy with docetaxel was synchronously conducted. The recent efficacy (tumor regression condition was observed at 3 months after the treatment), 1-year, 3-year and 5-year overall survival (OS), local-regional control (LRC), progression-free survival (PFS), disease-free survival (DFS) and the incidence rate of adverse reactions of patients in the two groups were compared. In the observation group, 73 patients completed the radiotherapy and chemotherapy, while all the patients in the control group completed the treatments. The 1-year OS of the observation group and the control group was 97.3 and 85.3%, respectively. In the observation group, the 3-year LRC, OS, PFS and DFS of the observation group was 94.5, 91.8, 90.4 and 87.7%, respectively; the 5-year LRC, OS, PFS and DFS was 64.4, 56.2, 56.2 and 54.8%, respectively. In the control group, the 3-year LRC, OS, PFS and DFS was 86.7, 73.3, 82.7 and 68.0%, respectively; the 5-year LRC, OS, PFS and DFS were 54.7, 45.3, 44.0 and 56.7%, respectively. The differences were statistically significant (P<0.05). In the observation group, the number of leukocytes was decreased, and the incidence rates of acute oropharyngeal mucosa reaction and radiation dermatitis were significantly lower than those in the control group. The differences were statistically significant (P<0.05). In conclusion, IMRT combined with chemotherapy can improve the OS and the 3-year and 5-year LRC, PFS and DFS of elderly patients with locally advanced oropharyngeal cancer, reduce toxic and side effects, and improve patients' quality of life.

Intensity-modulated radiotherapy plus nimotuzumab with or without concurrent chemotherapy for patients with locally advanced nasopharyngeal carcinoma.

ObjectiveThis study aimed to evaluate the safety and efficacy of intensity-modulated radiotherapy (IMRT) plus nimotuzumab with or without concurrent chemotherapy (CCT) for patients with locally advanced nasopharyngeal carcinoma (LA-NPC).Patients and methodsA total of 50 newly diagnosed patients with LA-NPC treated at the Affiliated Hospital of Jiangnan University between November 2011 and January 2017 were retrospectively analyzed. All patients received the combined treatment modality of nimotuzumab plus IMRT. Nimotuzumab was administered concurrently with IMRT at a weekly dose of 200 mg. Neoadjuvant, concurrent or adjuvant chemotherapy with the doublet regimen of taxanes (docetaxel or paclitaxel) plus platinum (cisplatin or nedaplatin) were administered. Among the 50 patients, 43 (86.0%) received ≥6 cycles of nimotuzumab (median 7 cycles, range 2–14 cycles) and 29 (58.0%) received two cycles of CCT with docetaxel plus nedaplatin.ResultsWith a median follow-up of 28.0 months, the 2-year progression-free survival (PFS) and overall survival were 83.29% (95% confidence interval [CI]: 67.93%–91.72%) and 97.67% (95% CI: 84.62%–99.67%), respectively. Both univariate and multivariate analyses revealed that cycles of nimotuzumab were significantly associated with PFS. Patients who received ≥6 cycles of nimotuzumab showed a better PFS than those receiving <6 cycles (P=0.006), whereas the addition of CCT failed to improve PFS. Oral mucositis was the most common adverse event, which was recorded as grade 3–4 in 18 (36.0%) patients. Besides, two (4.0%) patients experienced nimotuzumab-related anaphylaxis, and no skin rash was found in any patient. Subgroup analysis revealed that the patients who received CCT had more grade 3–4 adverse events as compared to those who did not receive CCT (62.1% vs 33.3%, P=0.045).ConclusionThe regime of nimotuzumab plus IMRT for the treatment of LA-NPC was well tolerated, with encouraging survival data, and it could be an effective treatment alternative for patients with LA-NPC. Further clinical trials are needed to confirm these findings.

The effect of parotid gland-sparing intensity-modulated radiotherapy on salivary composition, flow rate and xerostomia measures.

To describe parotid gland (PG) saliva organic and inorganic composition and flow rate changes, after curative intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and analyse the relationship between PG saliva analytes and xerostomia measures. Twenty-six patients recruited to five prospective phase 2 or 3 trials which assessed toxicity and efficacy of IMRT by HNC subsite, provided longitudinal PG saliva. Salivary flow rate, and subjective and objective xerostomia measures were prospectively collected and saliva tested for inorganic and organic analytes. Statistical comparisons of longitudinal analyte changes and analysis for a relationship between dichotomized xerostomia score and saliva analytes were performed. One hundred and forty-two PG saliva samples from 26 patients were analysed. At 3-6months after IMRT, stimulated and unstimulated saliva showed significantly decreased flow rate, total protein (TP) secretion rate, phosphate concentration and increased lactoferrin (LF) concentration. Stimulated saliva alone had elevated LF secretion rate and beta-2-microglobulin (B2 M) concentration with decreased calcium (Ca2+ ) and magnesium (Mg2+ ) concentrations and Ca2+ secretion rate. At >12months, under stimulated and unstimulated conditions, increased LF concentration and decreased Mg2+ and phosphate concentration persisted and, in stimulated saliva, there was decreased potassium (K+ ) and Mg2+ concentration. Unstimulated TP secretion rate was lower in the presence of high-grade xerostomia. Otherwise, no relationship between xerostomia grade and PG salivary flow rate, TP and Ca2+ secretion rate was found. Fewer significant differences in PG saliva analytes >12months after IMRT indicate good functional recovery. Residual xerostomia after IMRT will only be further reduced by addressing the sparing of subsites of the PG or other salivary gland tissues, in addition to the PG.

Long-term outcomes of intensity-modulated radiotherapy following extra-pleural pneumonectomy for malignant pleural mesothelioma

Background: The purpose was to evaluate safety and efficacy of intensity-modulated radiotherapy (IMRT) following extra-pleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM).Material and methods: Patients with MPM of clinical stage I–III, which were macroscopic completely resected with EPP were eligible for this prospective study. The ipsilateral hemithorax was irradiated with a prescribed dose of 50.4 Gy. When the high-risk surgical margins or FDG-avid regions were identified, simultaneous integrated boost (SIB) with 56.0 Gy or 61.6 Gy was applied.Results: Twenty-one patients were enrolled. SIB was applied to five patients. The planned IMRT fractions were completed in all, but four patients who suffered from severe fatigue or radiation pneumonitis. With a potential median follow-up of 6.3 years, overall survival was 37.5% at 3 years since the IMRT. The median survival time was 17.5 and 27.0 months since the IMRT and the initial treatment, respectively. Three patients have survived for more than 5 years. Distant metastasis was observed in 15 patients. Local recurrence was also observed in 2 of the 15 patients. Acute toxicities of Grade 3 or worse were observed in 15 patients, including 9 with hematological, 3 with pneumonitis and 6 with fatigue, nausea or vomiting. Five patients developed Grade 3 or worse late toxicities associated with IMRT, consisting of one with persistent Grade 4 thrombocytopenia, one with brain infarction and congestive liver dysfunction, and three with elevation of serum transaminase or biliary enzyme. No Grade 5 toxicity was observed. Patients with N2 showed significantly worse survival than those with N0–1 (18.2% vs. 60.0% at 3 years, p = .014).Conclusion: IMRT following EPP achieved excellent local control for MPM, that might lead to the long-term survival in selected patients. However, treatment burden including acute and late toxicities should be considered in this treatment approach.

Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma

PurposeSpermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas. Patients and methodsOur series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy were: R1 status after initial surgery, R1 status after wide en bloc resection and orchiectomy, high French federation of cancer centers (FNCLCC) grade, tumor size over 5cm, tumor resection during surgery. ResultsMedian age at diagnosis was 66years (range 46–84years). Median follow-up was 18months (range 6–28months). Four patients had repeat surgery after incomplete removal. All surgeries were orchidectomy with primary ligation of testicular vessels. One patient did not have an in sano margin after the second surgical procedure. The median tumor size was 60mm (range 30–150mm). No recurrence was observed during the follow-up. ConclusionNo grade 4 toxicities were reported and the most frequent acute toxicity was dermatitis. No recurrence was reported after adjuvant intensity-modulated radiotherapy. The treatment is feasible and well tolerated and seems to provide encouraging results regarding locoregional control of the disease. Dynamic or rotational intensity-modulated radiotherapy is now recommended to decrease acute toxicities while improving the efficacy of this approach.

Efficacy of intensity-modulated radiotherapy on patients with locally recurrent nasopharyngeal carcinoma

Objective This study retrospectively analyzed the efficacy and toxicity profile of hyperfractionated intensity-modulated radiotherapy (HF-IMRT) for locally recurrent nasopharyngeal carcinoma (NPC). Methods Twenty-eight locally recurrent patients of NPC were enrolled, 23 male and 5 female with a median of 51 years (range 25-74 years). All patients had a median recurrent time of 17.5 months and received HF-IMRT with a total dosage of 60-70 Gy, each consisting of 1.2 Gy per fraction, each of the 2 fractions were spaced 6 hours apart and lasting for 5 days. Twenty-five patients received concurrent chemotherapy of nedaplatin or two agent regimen, 4 patients received Ad-p53 gene therapy and 6 patients received target therapy of EGFR monoclony antibody. Results The complete response and partial response rates were 89%(25/28) and 11%(3/28) after being treated by HF-IMRT for 3 months. The median follow-up time was 27.5 months. The 1, 2, 3-year overall survival rates, locoregional recurrence-free survival rates and progression-free survival rates were 100%, 91%, 80%; 100%, 80%, 55%; 88%, 65%, 55%, respectively. Three patient were observed to develop severe nasopharyngeal necrosis but recover after treatment, no patients experienced hemorrhage of nasopharynx. Multivariate analysis indicated that the poor prognostic factors included tumor stages (T3-T4)(P=0.00) and no chemotherapy (P=0.04). Conclusion HF-IMRT is feasible for locally recurrent nasopharyngeal carcinoma with satisfactory local control and controllable adverse reaction, it is worth further clinical studies. Key words: Neoplasmso recurrent, Nasopharyngeal/radiotherapy; Radiotherapy, hyperfractionated; Radiotherapy, intensity-modulated; Treatment outcome; Side-efficacy

A retrospective study on intensity-modulated radiation therapy combined with chemotherapy after D2 radical surgery for gastric carcinoma.

In order to investigate the clinical value of different chemotherapies, the efficacy of intensity-modulated radiation therapy with concurrent chemotherapy following D2 radical surgery for gastric carcinoma was evaluated in this study. A total of 102 patients who underwent D2 radical surgery for gastric carcinoma followed by concurrent chemoradiotherapy (CRT) between January, 2008 and March, 2012, were selected. The 5/7 field intensity-modulated radiation therapy was used, with a planning target volume dose of 45 Gy in 25 fractions over 5 weeks. Among these patients, 45 were administered 400 mg/m2/day fluorouracil and 20 mg/m2/day tetrahydrofurfuryl alcohol through intravenous infusion 4 days before and 3 days after the radiotherapy (F-CRT group), while 57 patients received 825 mg/m2 capecitabine orally twice a day (C-CRT group). The 3-year overall and the disease-free survival rates were 75.5 and 70.5%, respectively. The overall 3-year survival rates of the F-CRT and C-CRT groups were 72.2 and 78.5% (P>0.05), respectively, and the 3-year disease-free survival rates were 67.7 and 72.8% (P>0.05), respectively. No significant differences were observed between the two groups. However, during the concurrent CRT, significant differences were found in the incidence of grade 1-2 haematological toxicity between the F-CRT and C-CRT groups (73.3 vs. 50.9%, respectively; χ2 =5.320, P=0.021). Significant differences were also found in the incidence of grade 1-2 gastrointestinal reactions between the two groups (77.8 vs. 57.9%, respectively; χ2=4.474, P=0.034). Therefore, intensity-modulated radiation therapy combined with concurrent chemotherapy following D2 radical surgery for gastric cancer was found to be safe and effective. In addition, radiotherapy was better tolerated and more likely to be completed using C-CRT rather than F-CRT.

Intensity-modulated Radiation Therapy for Anal Cancer: Results From a Multi-Institutional Retrospective Cohort Study.

To assess toxicity and efficacy of intensity-modulated radiation therapy (IMRT) for anal cancer. Records of 152 patients were reviewed retrospectively from multiple institutions. Data on disease control and toxicity were collected as well as patient and treatment characteristics. Acute (<6 mo) and late (≥6 mo) severe toxicity (grade ≥3) were graded. Four patients were excluded due to the presence of metastatic disease or stage TX. Late toxicity data were available for 120 patients. Median cumulative IMRT dose was 51.25 Gy (median, 28 fractions). All but 2 patients received chemotherapy. With median follow-up of 26.8 months, local control at 3 years was 87%, worse for patients with T3-T4 than T1-T2 disease on univariate analysis (79% vs. 90%; P=0.04). Regional control, distant control, and overall survival were 97%, 91%, and 87%, respectively, at 3 years. Nodal status was associated with regional control, distant control, and overall survival (P<0.01 for each). Most common severe acute toxicity was hematologic (41%), skin (20%), and gastrointestinal tract (11%). Two grade 5 toxicities occurred (hematologic and gastrointestinal tract). Severe late toxicity affected skin (1%) and gastrointestinal tract (3%). IMRT with chemotherapy resulted in excellent local control. Although T stage predicted worse local control, most T3-T4 disease was controlled with IMRT. Nodal status predicted regional and distant control and overall survival. Severe toxicity was acceptable.

Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of nasopharyngeal carcinoma and its influencing factors: an analysis of 454 patients

Objective To analyze the long-term efficacy of intensity-modulated radiotherapy (IMRT) with or without chemotherapy in treatment of 454 patients with nasopharyngeal carcinoma (NPC) and its influencing factors. Methods A retrospective analysis was performed on the clinical data of 454 patients with non-metastatic NPC who received IMRT with or without chemotherapy in our center from 2007 to 2012. Prescribed doses of 69.96-73.92 Gy in 33 fractions, 69.96 Gy in 33 fractions, 60.06 Gy in 33 fractions, and 50.96 Gy in 28 fractions were applied to nasopharyngeal gross tumor volume, cervical metastatic lymph nodes, high-risk drainage area, and low-risk drainage area, respectively. In all patients, 438 received induction chemotherapy, 420 concurrent chemotherapy, and 216 adjuvant chemotherapy, most of which were based on cisplatin and taxol. The Kaplan-Meier method was used for calculating survival rates and the log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox model was used for the multivariate prognostic analysis. Results The 3-year sample size was 210. The 3-year overall survival (OS), local recurrence-free survival, nodal relapse-free survival, progression-free survival, and distant metastasis-free survival (DMFS) rates were 88.1%, 91.0%, 90.7%, 80.5%, and 85.1%, respectively. Age, T stage, and N stage were influencing factors for the OS rate (P=0.011; P=0.005; P=0.033); T stage and N stage were influencing factors for the disease progression-free survival (P=0.017; P=0.005) and DMFS (P=0.012; P=0.019). The grade ≥3 acute and late adverse reactions included hematological toxicity, oral mucositis, xerostomia, dysphagia, and brain injury. Conclusions IMRT promotes the long-term survival rates in patients with NPC. The distant metastasis is the major reason for treatment failure. The adverse reactions induced by IMRT combined with chemotherapy are tolerable. Key words: Nasopharyngeal neoplasms/radiotherapy; Radiotherapy, intensity-modulated; Prognosis

An analysis of efficacy of intensity-modulated radiotherapy with concurrent chemotherapy for stage T1-2N1 nasopharyngeal carcinoma

Objective To retrospectively analyze the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) alone and IMRT with concurrent chemotherapy (CRT) in the treatment of early-stage nasopharyngeal carcinoma (NPC) using pairwise group comparison. Methods A total of 98 patients with stage T1-2N1M0 NPC were treated with IMRT alone or CRT from 2009 to 2010, and 39 pairs out of them were selected for comparison of efficacy and toxicity. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. Results The 3-year follow-up rate was 95%. There were no significant differences in the 3-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates between the IMRT alone group and the CRT group (97% vs. 95%, P=0.411; 97% vs. 92%, P=0.301; 97% vs. 97%, P=0.606; 100% vs. 92%, P=0.082). The incidence rates of leucopenia, anemia, and thrombocytopenia were significantly higher in the CRT group than in the IMRT alone group (P=0.000; P=0.000; P=0.000). There were no significant differences in the incidence rates of grade 3 oral mucositis and hearing loss between the IMRT alone group and the CRT group (26% vs. 23%, P=0.093; 41% vs. 62%, P=0.100). Conclusions CRT fails to increase the OS, PFS, and LRFS rates and reduce the DMFS rate in patients with stage T1-2N1 NPC. Moreover, CRT results in higher incidence rates of hematotoxicity, grade 3 mucositis, and hearing loss than IMRT alone. Key words: Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Nasopharyngeal neoplasms/concurrent chemoradiotherapy; Prognosis