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Article: Radiotherapy for nasopharyngeal carcinoma: Shielding the pituitary may improve therapeutic ratio

TitleRadiotherapy for nasopharyngeal carcinoma: Shielding the pituitary may improve therapeutic ratio
Authors
Issue Date1994
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ijrobp
Citation
International Journal of Radiation Oncology - Biology - Physics, 1994, v. 29 n. 4, p. 699-704 How to Cite?
AbstractPurpose: Nasopharyngeal carcinoma (NPC) is well known for its invasiveness and erosion of the base of the skull is not uncommon. Before the advent of computed tomography, the evaluation of the base of the skull was by plain radiography. Because of the low sensitivity of these investigations, traditional teaching has included the sphenoid sinus in the volume of irradiation. Increase in longevity of patients allows the manifestation and documentation of the long-term sequelae of irradiating the hypothalamic- pituitary axis and the temporal lobes. This study is an attempt to evaluate whether the hypothalamic-pituitary axis can be shielded from the target volume in a proportion of NPC patients. Methods and Materials: One hundred fifty-two NPC patients with no evidence of erosion of the base of the skull and sphenoid, nor extension to the nasal fossa and ethmoid sinuses were randomized to receive standard radiotherapy covering the whole sphenoid sinus or radiotherapy using a modified technique that shields the pituitary and the anterior part of the hypothalamus. This modified technique also shields a large part of the lower temporal lobes that are otherwise covered by standard treatment portals. The characteristics and treatment of the two subgroups of patients were otherwise comparable. Results: At a median follow-up of 31.5 months, the tumor control between the two subgroups of patients were comparable (p = 0.3928). However, 8 of the 71 patients in the unshielded group had developed symptomatic neuroendocrine complications, while none of the other group did (p = 0.0061). Two patients developed secondary hypothyroidism, one patient developed oligomenorrhoea associated with raised prolactin, and five patients developed temporal lobe necrosis. Conclusions: The protective effect on neuroendocrine complication of this shield was demonstrated at median follow-up of 31.5 months, and the local control was not jeopardized. Modification of treatment technique as presently described, which is applicable to one-third of NPC patients to improve the therapeutic ratio, is recommended for general use.
Persistent Identifierhttp://hdl.handle.net/10722/150707
ISSN
2015 Impact Factor: 4.495
2015 SCImago Journal Rankings: 2.274
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorSham, Jen_US
dc.contributor.authorChoy, Den_US
dc.contributor.authorKwong, PWKen_US
dc.contributor.authorCheng, ACKen_US
dc.contributor.authorKwong, DLWen_US
dc.contributor.authorYau, CCen_US
dc.contributor.authorWan, KYen_US
dc.contributor.authorAu, GKHen_US
dc.date.accessioned2012-06-26T06:09:03Z-
dc.date.available2012-06-26T06:09:03Z-
dc.date.issued1994en_US
dc.identifier.citationInternational Journal of Radiation Oncology - Biology - Physics, 1994, v. 29 n. 4, p. 699-704en_US
dc.identifier.issn0360-3016en_US
dc.identifier.urihttp://hdl.handle.net/10722/150707-
dc.description.abstractPurpose: Nasopharyngeal carcinoma (NPC) is well known for its invasiveness and erosion of the base of the skull is not uncommon. Before the advent of computed tomography, the evaluation of the base of the skull was by plain radiography. Because of the low sensitivity of these investigations, traditional teaching has included the sphenoid sinus in the volume of irradiation. Increase in longevity of patients allows the manifestation and documentation of the long-term sequelae of irradiating the hypothalamic- pituitary axis and the temporal lobes. This study is an attempt to evaluate whether the hypothalamic-pituitary axis can be shielded from the target volume in a proportion of NPC patients. Methods and Materials: One hundred fifty-two NPC patients with no evidence of erosion of the base of the skull and sphenoid, nor extension to the nasal fossa and ethmoid sinuses were randomized to receive standard radiotherapy covering the whole sphenoid sinus or radiotherapy using a modified technique that shields the pituitary and the anterior part of the hypothalamus. This modified technique also shields a large part of the lower temporal lobes that are otherwise covered by standard treatment portals. The characteristics and treatment of the two subgroups of patients were otherwise comparable. Results: At a median follow-up of 31.5 months, the tumor control between the two subgroups of patients were comparable (p = 0.3928). However, 8 of the 71 patients in the unshielded group had developed symptomatic neuroendocrine complications, while none of the other group did (p = 0.0061). Two patients developed secondary hypothyroidism, one patient developed oligomenorrhoea associated with raised prolactin, and five patients developed temporal lobe necrosis. Conclusions: The protective effect on neuroendocrine complication of this shield was demonstrated at median follow-up of 31.5 months, and the local control was not jeopardized. Modification of treatment technique as presently described, which is applicable to one-third of NPC patients to improve the therapeutic ratio, is recommended for general use.en_US
dc.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ijrobpen_US
dc.relation.ispartofInternational Journal of Radiation Oncology - Biology - Physicsen_US
dc.subject.meshAdulten_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshHypothalamo-Hypophyseal System - Radiation Effectsen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshNasopharyngeal Neoplasms - Epidemiology - Radiotherapyen_US
dc.subject.meshPituitary Gland - Radiation Effectsen_US
dc.subject.meshPituitary-Adrenal System - Radiation Effectsen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshRadiation Protectionen_US
dc.subject.meshSphenoid Sinus - Pathology - Radiation Effectsen_US
dc.titleRadiotherapy for nasopharyngeal carcinoma: Shielding the pituitary may improve therapeutic ratioen_US
dc.typeArticleen_US
dc.identifier.emailKwong, DLW:dlwkwong@hku.hken_US
dc.identifier.authorityKwong, DLW=rp00414en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid8040015-
dc.identifier.scopuseid_2-s2.0-0028107877en_US
dc.identifier.volume29en_US
dc.identifier.issue4en_US
dc.identifier.spage699en_US
dc.identifier.epage704en_US
dc.identifier.isiWOS:A1994NZ48200008-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridSham, J=7101655565en_US
dc.identifier.scopusauthoridChoy, D=7102939127en_US
dc.identifier.scopusauthoridKwong, PWK=7006992418en_US
dc.identifier.scopusauthoridCheng, ACK=36788758900en_US
dc.identifier.scopusauthoridKwong, DLW=15744231600en_US
dc.identifier.scopusauthoridYau, CC=7007038422en_US
dc.identifier.scopusauthoridWan, KY=7102748975en_US
dc.identifier.scopusauthoridAu, GKH=36772162400en_US

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