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Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

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Chinese Journal of Cancer 2016年第12期35卷 725-734页

作者： Yu-Xiang He Ying Wang Peng-Fei Cao Lin Shen Ya-Jie Zhao Zi-Jian Zhang Deng-Ming Chen Tu-Bao Yang Xin-Qiong Huang Zhou Qin You-Yi Dai Liang-Fang Shen Department of Oncology Xiangya HospitalCentral South University Department of Hematology Xiangya HospitalCentral South University Department of Radiology Xiangya HospitalCentral South University School of Public Health Central South University

Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy(IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ind a suitable cut?of value of GTV?P for prognosis prediction.Methods: Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic(ROC) curves were used to identify the cut?of values of GTV?P for the prediction of diferent end?points [overall survival(OS), local relapse?free survival(LRFS), distant metastasis?free survival(DMFS), and disease?free survival(DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system.Results: The 358 patients with locally advanced NPC were divided into two groups by the cut?of value of GTV?P as determined using ROC curves: 219(61.2%) patients with GTV?P ≤46.4 mL and 139(38.8%) with GTV?P >46.4 mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P ≤46.4 mL than in those with GTV?P > 46.4 mL(all P 46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriied that the predictive ability of GTV?P was superior to that of T category(P 46.4 mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.

关键词： Nasopharyngeal carcinoma intensity-modulated radiotherapy Gross target volume of primary tumor Prognosis

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A model to predict the risk of lethal nasopharyngeal necrosis after re-irradiation with intensity-modulated radiotherapy in nasopharyngeal carcinoma patients

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Chinese Journal of Cancer 2016年第11期35卷 617-624页

作者： Ya-Hui Yu Wei-Xiong Xia Jun-Li Shi Wen-Juan Ma Yong Li Yan-Fang Ye Hu Liang Liang-Ru Ke Xing Lv Jing Yang Yan-Qun Xiang Xiang Guo State Key Laboratory of Oncology in South China Collaborative Innovation Center of Cancer MedicineSun Yat-sen University Cancer Center Department of Nasopharyngeal Carcinoma Sun Yat-sen University Cancer Center Department of Biodevices and Diagnostics Institute of Bioengineering and NanotechnologySingapore Department of Radiation Therapy 3rd Affiliated Hospital of Guangzhou Medical University Department of Pathology Sun Yat-sen University Cancer Center Department of Biostatistics and Epidemiology School of Public HealthSun Yat-sen University

Background:For patients with nasopharyngeal carcinoma(NPC) who undergo re-irradiation with intensity-modulated radiotherapy(IMRT),lethal nasopharyngeal necrosis(LNN) is a severe late adverse event.The purpose of this study was to identify risk factors for LNN and develop a model to predict LNN after radical re-irradiation with IMRT in patients with recurrent NPC.Methods:Patients who underwent radical re-irradiation with IMRT for locally recurrent NPC between March 2001 and December 2011 and who had no evidence of distant metastasis were included in this study.Clinical characteristics,including recurrent carcinoma conditions and dosimetric features,were evaluated as candidate risk factors for LNN.Logistic regression analysis was used to identify independent risk factors and construct the predictive scoring model.Results:Among 228 patients enrolled in this study,204 were at risk of developing LNN based on risk analysis.Of the 204 patients treated,31(15.2%) developed LNN.Logistic regression analysis showed that female sex(P = 0.008),necrosis before re-irradiation(P = 0.008),accumulated total prescription dose to the gross tumor volume(GTV) ≥ 145.5 Gy(P = 0.043),and recurrent tumor volume >25.38 cm3(P = 0.009) were independent risk factors for LNN.A model to predict LNN was then constructed that included these four independent risk factors.Conclusions:A model that includes sex,necrosis before re-irradiation,accumulated total prescription dose to GTV,and recurrent tumor volume can effectively predict the risk of developing LNN in NPC patients who undergo radical re-irradiation with IMRT.

关键词： Nasopharyngeal carcinoma Re-irradiation intensity-modulated radiotherapy Necrosis

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Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

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Chinese Journal of Cancer 2016年第12期35卷 673-682页

作者： Yan-Ping Mao Ling-Long Tang Lei Chen Ying Sun Zhen-Yu Qi Guan-Qun Zhou Li-Zhi Liu Li Li Ai-Hua Lin Jun Ma State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer Center Department of Radiation Oncology Sun Yat-sen University Cancer Center Imaging Diagnosis and Interventional Center Sun Yat-sen University Cancer Center Department of Medical Statistics and Epidemiology School of Public HealthSun Yat-sen University

Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.

关键词： Nasopharyngeal carcinoma intensity-modulated radiotherapy Prognosis Failure pattern Tumor staging

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Effect of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy on clinical outcomes in patients with glioblastoma multiforme

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Chinese Medical Journal 2013年第12期126卷 2320-2324页

作者： CHEN Yi-dong FENG Jin FANG Tong YANG Ming QIU Xiao-guang JIANG Tao Department ofOncology Beijing Shiiit Hospital Capital Medical University Beijing 100038 China Department of Radiation Oncology Beijing Puren Hospital Beijing 100062 China College of Life Science and Technology Beijing University of Chemical Technology Beijing t00029 China Department of Radiation Oncology Tiantan Hospital Capital Medical University Beijing 100050 China Department of Neurosurgery Tiantan Hospital Capital Medical University Beijing 100050 China

Background Few studies were reported on the comparison of clinical outcomes between intensity-modulated radiotherapy （IMRT） and three-dimensional conformal radiotherapy （3D-CRT） in the treatment of glioblastoma multiforme （GBM）.This study aimed to determine whether IMRT improves clinical outcomes compared with 3D-CRT in patients with GBM.Methods The records of 54 patients with newly-diagnosed GBM from July 2009 to December 2010 were reviewed.The patients underwent postoperative IMRT or 3D-CRT with concurrent and adjuvant temozolomide.Kaplan-Meier method and log rank test were used to estimate differences of patients＇ survival.Results The median follow-up was 13 months.Of the 54 patients,fifty （92.6%） completed the combined modality treatment.The 1-year overall survival rate （OS） was 79.6%.The pattern of failure was predominantly local.A comparative analysis revealed that no statistical difference was observed between the IMRT group （n=21） and the 3D-CRT group （n=33） for 1-year OS （89.6% vs.75.8%,P=0.795）,or 1-year progression-free survival （PFS）（61.0% vs.45.5%,P=0.867）.In dosimetric comparison,IMRT seemed to allow better sparing of organs at risk than 3D-CRT did （P=0.050,P=0.055）.However,there was no significant difference for toxicities of irradiation between the IMRT group and the 3D-CRT group.Conclusions Our preliminary results suggested that delivering standard radiation doses by IMRT is unlikely to improve local control or overall survival for GBM compared with 3D-CRT.Given this lack of survival benefit and increased costs of IMRT,the utilization of IMRT treatment for GBM needs to be carefully rationalized.

关键词： glioblastoma multiforme three-dimensional conformal radiotherapy intensity-modulated radiotherapy

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Long-term outcome of a moderately hypofractionated, intensity-modulated radiotherapy approach using an endorectal balloon for patients with localized prostate cancer

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Cancer Communications 2018年第1期38卷 136-144页

作者： Bin S.Teh Gary D.Lewis Weiyuan Mai Ramiro Pino Hiromichi Ishiyama Edward Brian Butler Department of Radiation Oncology Houston Methodist HospitalCancer Centerand Research InstituteWeill Cornell Medical College6565 FanninSte#DB1-077HoustonTX 77030USA Department of Radiation Oncology The University of Texas Medical Branch at GalvestonGalvestonTX 77555USA Department of Radiation Oncology Baylor College of MedicineHoustonTX 77030USA Department of Radiology and Radiation Oncology Kitasato University School of MedicineSagamihara 252-0374Japan

Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate cancer is unclear.Laboratory and clinical evidence suggest that hypofractionation may improve the therapeutic ratio of radiotherapy.We report our institutional outcomes using moderately hypofractionated,intensity-modulated radio-therapy(IMRT),and an endorectal balloon,with emphasis on long-term biochemical control and treatment-related adverse events in patients with localized prostate cancer.Methods:Between January 1997 and April 2004,596 patients with cT1-T3 prostate cancer underwent IMRT using a moderate hypofractionation regimen(76.70 Gy at 2.19 Gy/fraction)with an endorectal balloon.Using D’Amico clas-sification,226(37.9%),264(44.3%),and 106(17.8%)patients had low-,intermediate-,or high-risk disease,respectively.The majority of intermediate-and high-risk patients received androgen deprivation therapy.Biochemical relapse-free survival(bRFS)was evaluated using 2005 Phoenix criteria and estimated using the Kaplan-Meier method.Results:The median follow-up was 62 months.Overall 5-and 10-year bRFS rates were 92.7%and 87.7%.For low-,intermediate-,and high-risk patients,the 5-year bRFS rates were 96.9%,93.3%,and 82.0%,respectively;the 10-year bRFS rates were 91.4%,89.3%,and 76.2%,respectively.Prostate-specific antigen,Gleason score,and T stage were significant predictors of bRFS(all P<0.01).The 5-year rates of severe(≥Grade 3)adverse events were very low:1.2%for gastrointestinal events and 1.1%for genitourinary events.Conclusions:Long-term outcomes after moderately hypofractionated IMRT are encouraging.Moderate hypofrac-tionation represents a safe,efficacious,alternative regimen in the treatment of localized prostate cancer.

关键词： Prostate cancer intensity-modulated radiotherapy Moderate hypofractionation

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Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma

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Cancer Communications 2019年第1期39卷 634-644页

作者： You-Ping Liu Xing Lv Xiong Zou Yi-Jun Hua Rui You Qi Yang Le Xia Shao-Yan Guo Wen Hu Meng-Xia Zhang Si-Yuan Chen Mei Lin Yu-Long Xie Li-Zhi Liu Rui Sun Pei-Yu Huang Wei Fan Xiang Guo Ming-Huang Hong Ming-Yuan Chen Department of Nasopharyngeal Carcinoma Sun Yat-sen University Cancer Center651 Dongfeng East RoadGuangzhou 510060GuangdongP.R.China State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Medical Imaging and Interventional Radiology Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Nuclear Medicine Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Clinical Trials Center Sun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China

Background:The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy(IMRT)as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma(NPC),but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients.Endoscopic nasopharyngectomy(ENPG)was successfully applied in recurrent NPC with radiation free and relatively low medical costs.In this study,we examined whether ENPG could be an effective treatment for localized stage I NPC.Methods:Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center.Simultaneously,the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort.The survival outcomes,quality of life(QOL),and medical costs between two groups were compared.Results:After a median follow-up of 59.0 months(95%CI 53.4-64.6),no death,locoregional recurrence,or distant metastasis was observed in the 10 patients treated with ENPG.The 5-year overall survival,local relapse-free survival,regional relapse-free survival,and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients(100%vs.99.1%,100%vs.97.7%,100%vs.99.0%,100%vs.97.4%,respectively,P>0.05).In addition,compared with IMRT,ENPG was associated with decreased total medical costs($4090.42±1502.65 vs.$12620.88±4242.65,Pradiotherapy.However,the application of ENPG should be prudent,and prospective clinical tri-als were needed to further verify the results.

关键词： Nasopharyngeal carcinoma Localized Early stage Endoscopic nasopharyngectomy intensity-modulated radiotherapy Survival Medical cost Quality of life

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Three-Dimensional Conformal and intensity modulated Dynamic radiotherapy in Juvenile Nasopharyngeal Angiofibroma

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第4期12卷 269-278页

作者： María Fátima Chilaca Rosas David Rafael Salazar Calderon Manuel Tadeo Contreras Aguilar Carlos Eduardo Barrios Merino Melissa García Lezama Benjamín Conde Castro Shelley Astrid Martínez Torres Katia Hernández Salgado Rafael Medrano Guzmán radiotherapy Department Oncology Hospital of National Medical Center s. XII Mexican Social Security Institute Mexico City Mexico Directorate of Research General Hospital of Mexico “Dr. Eduardo Liceaga” Mexico City Mexico Research Department in Imaging “Salud Digna” Mexico City Mexico Directorate Oncology Hospital of National Medical Center s. XII Mexican Social Security Institute Mexico City Mexico

Objective: Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign neoplasm with a high vascularity component, greater craniofacial involvement in adolescent patients, and aggressive local behaviour. In unresectable patients, radiotherapy is a therapeutic option for local control. Our aim in this study was to analyze the clinical benefit and local control provided by two modalities of radiotherapy: the Three-Dimensional Conformal (3DC) technique and volumetric modulated arc therapy (VMAT), applied to pediatric patients with JNA considered unresectable and non-recurrent. Methods: In retrospective study, the information was recorded from pediatric patients with a diagnosis of non-recurrent and unresectable JNA treated with radiotherapy at the Oncology Hospital of the National Medical Center SXXI of Mexico City, from March 2010 to March 2021. radiotherapy management and its association with clinical outcomes of tumour control, and symptoms were assessed. In addition, an evaluation of acute and chronic toxicity was performed. Results: It was found that the median age was 14 years. 9 patients (37.5%) underwent 3DC and 15 (62.5%) VMAT. In terms of local control, and progression-free survival, we did not find significant difference between radiotherapy modalities (p ≤ 0.57). Acute toxicity for both modalities presented statistical differences for radio epithelitis (p = 0.03). Only Grade I and II radiation-induced acute toxicity was observed. Regarding chronic toxicity, statistical significance was observed for craniofacial hypoplasia, in relation to its absence in the VMAT group (p = 0.001). Conclusion: The VMAT presents improvements in dosimetry parameters that improve patient toxicity. In both techniques adequate tumour control was observed, however, the rarity of the disease is a limitation to establish the most appropriate therapeutic technique.

关键词： intensity-modulated radiotherapy Nasopharyngeal Angiofibroma Pediatric radiotherapy Toxicity

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Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

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World Journal of Gastroenterology 2023年第8期29卷 1344-1358页

作者： Chen-Ying Ma Jing Zhao Guang-Hui Gan Xiao-Lan He Xiao-Ting Xu Song-Bing Qin Li-Li Wang Li Li Ju-Ying Zhou Radiation Oncology The First Affiliated Hospital of Soochow UniversitySuzhou 215123Jiangsu ProvinceChina State Key Laboratory of Radiation Medicine and Protection Soochow UniversitySuzhou 215123Jiangsu ProvinceChina

BACKGROUND Cervical cancer is one of the most common gynecological malignant tumors.Radiation enteritis(RE)leads to radiotherapy intolerance or termination of radiotherapy,which negatively impacts the therapeutic effect and seriously affects the quality of life of patients.If the incidence of RE in patients can be predicted in advance,and targeted clinical preventive treatment can be carried out,the side effects of radiotherapy in cervical cancer patients can be significantly reduced.Furthermore,accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan.AIM To analyze the relationships between severe acute RE(SARE)of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively.METHODS We included 50 cervical cancer patients who received volumetric modulated arc therapy(VMAT)from September 2017 to June 2018 in the Department of radiotherapy at The First Affiliated Hospital Soochow University.Clinical and dose-volume histogram factors of patients were collected.Logistic regression analysis was used to evaluate the predictive value of each factor for SARE.A nomogram to predict SARE was developed(SARE scoring system≥3 points)based on the multiple regression coefficients;validity was verified by an internal verification method.RESULTS Gastrointestinal and hematological toxicity of cervical cancer VMAT gradually increased with radiotherapy and reached the peak at the end of radiotherapy.The main adverse reactions were diarrhea,abdominal pain,colitis,anal swelling,and blood in the stool.There was no significant difference in the incidence of gastrointestinal toxicity between the radical and postoperative adjuvant radiotherapy groups(P>0.05).There were significant differences in the small intestine V_(20),V_(30),V_(40),and rectal V40 between adjuvant radiotherapy and radical radiotherapy after surgery(P<0.05).Univariate and multivariate analyses revealed anal bulge rating(OR:14.779,95%CI:1.281-170.547,P=0.031)and

关键词： Cervical cancer intensity-modulated radiotherapy Radiation enteritis Nomogram Predictor

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Dosimetry Comparison between Volumetric modulated Arc Therapy with RapidArc and Fixed Field Dynamic IMRT for Local-Regionally Advanced Nasopharyngeal Carcinoma

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Chinese Journal of Cancer Research 2011年第4期23卷 259-264页

作者： Bao-min Zheng Xiao-xia Dong Hao Wu You-jia Duan Shu-kui Han Yan Sun Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education) Department of RadiotherapyPeking University School of Oncology Beijing Cancer Hospital & Institute Beijing 100142 China

Objective: A dosimetric study was performed to evaluate the performance of volumetric modulated arc radiotherapy with RapidArc on locally advanced nasopharyngeal carcinoma (NPC). Methods: The CT scan data sets of 20 patients of locally advanced NPC were selected randomly. The plans were managed using volumetric modulated arc with RapidArc and fixed nine-field coplanar dynamic intensity-modulated radiotherapy (IMRT) for these patients. The dosimetry of the planning target volumes (PTV), the organs at risk (OARs) and the healthy tissue were evaluated. The dose prescription was set to 70 Gy to the primary tumor and 60 Gy to the clinical target volumes (CTV) in 33 fractions. Each fraction applied daily, five fractions per week. The monitor unit (MU) values and the delivery time were scored to evaluate the expected treatment efficiency. Results: Both techniques had reached clinical treatment’s requirement. The mean dose (Dmean), maximum dose (Dmax) and minimum dose (Dmin) in RapidArc and fixed field IMRT for PTV were 68.4±0.6 Gy, 74.8±0.9 Gy and 56.8±1.1 Gy; and 67.6±0.6 Gy, 73.8±0.4 Gy and 57.5±0.6 Gy (P0.05). Compared to IMRT, RapidArc allowed a reduction of Dmean to the brain stem, mandible and optic nerves of 14.1% (P<0.05), 5.6% (P<0.05) and 12.2% (P<0.05), respectively. For the healthy tissue and the whole absorbed dose, Dmean of RapidArc was reduced by 3.6% (P<0.05), and 3.7% (P<0.05), respectively. The Dmean to the parotids, the spinal cord and the lens had no statistical difference among them. The mean MU values of RapidArc and IMRT were 550 and 1,379. The mean treatment time of RapidArc and IMRT was 165 s and 447 s. Compared to IMRT, the delivery time and the MU values of RapidArc were reduced by 63% and 60%, respectively. Conclusion: For locally advanced NPC, both RapidArc and IMRT reached the clinic requirement. The target volume coverage wa

关键词： Volumetric modulated arc therapy intensity-modulated radiotherapy Dosimetry Target volume Nasopharyngeal carcinoma

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Technological advances in radiotherapy for esophageal cancer

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World Journal of Gastroenterology 2010年第44期16卷 5555-5564页

作者： Milan Vosmik Jiri Petera Igor Sirak Miroslav Hodek Petr Paluska Jiri Dolezal Marcela Kopacova Department of Oncology and radiotherapy Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital in Hradec Kralove Department of Nuclear Medicine Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital in Hradec Kralove 2nd Department of Medicine Charles University in PrahaFaculty of Medicine at Hradec KraloveUniversity Teaching Hospital in Hradec Kralove

radiotherapy with concurrent chemotherapy and surgery represent the main treatment modalities in esophageal cancer.The goal of modern radiotherapy approaches,based on recent technological advances,is to minimize post-treatment complications by improving the gross tumor volume definition (positron emission tomography-based planning),reducing interfraction motion (image-guided radiotherapy) and intrafraction motion (respiratory-gated radiotherapy),and by better dose delivery to the precisely defined planning target volume (intensity-modulated radiotherapy and proton therapy).Reduction of radiotherapy-related toxicity is fundamental to the improvement of clinical results in esophageal cancer,although the dose escalation concept is controversial.

关键词： Esophageal cancer intensity-modulated radiotherapy Positron emission tomography Imageguided radiotherapy Proton therapy

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