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Article: Evolution of treatment for nasopharyngeal cancer--success and setback in the intensity-modulated radiotherapy era

TitleEvolution of treatment for nasopharyngeal cancer--success and setback in the intensity-modulated radiotherapy era
Authors
KeywordsEfficacy
Late toxicity
Nasopharyngeal carcinoma
Radiotherapy
Chemotherapy
Issue Date2014
PublisherElsevier Ireland Ltd.
Citation
Radiotherapy & Oncology, 2014, v. 110 n. 3, p. 377-384 How to Cite?
AbstractBackground and purpose: To assess the therapeutic gains and setbacks as we evolved from the 2-dimensional radiotherapy (2DRT) to conformal 3-dimensional (3DRT) and to intensity-modulated (IMRT) era. MATERIALS AND METHODS: 1593 consecutive patients from 1994 to 2010 were retrospectively analyzed. Evolving changes in the different era included advances in staging investigation, radiotherapy technique, dose escalation, and use of chemotherapy. RESULTS: The 3DRT era achieved significant improvement in local failure-free rate (L-FFR), disease-specific survival (DSS) and overall survival (OS). Neurological damage and bone/soft tissue necrosis were significantly reduced. However, the improvement in distant failure-free rate (D-FFR) was insignificant, and more hearing impairment occurred due to chemotherapy. Significantly higher D-FFR was achieved in the IMRT era, but L-FFR did not show further improvement. 5-Year DSS increased from 78% in the 2DRT, to 81% in the 3DRT, and 85% in the IMRT era, while the corresponding neurological toxicity rate decreased from 7.4% to 3.5% and 1.8%. CONCLUSIONS: Significant improvement in survival and reduction of serious toxicity was achieved as we evolved from 2DRT to 3DRT and IMRT era; the therapeutic ratio for all T-categories improved with more conformal techniques. Improvements in tumor control were attributed not only to advances in RT technique, but also to better imaging and increasing use of potent chemotherapy. However, it should also be noted that hearing impairment significantly increased due to chemotherapy, L-FFR reached a plateau in the 3DRT era, and it is worrisome that the result for T4 remained unsatisfactory. Besides exploring for more potent chemotherapy and innovative methods, the guideline on dose constraint should be re-visited to optimize the therapeutic ratio.
Persistent Identifierhttp://hdl.handle.net/10722/198477
ISSN
2015 Impact Factor: 4.817
2015 SCImago Journal Rankings: 2.654

 

DC FieldValueLanguage
dc.contributor.authorLee, AWMen_US
dc.contributor.authorNg, WTen_US
dc.contributor.authorChan, LLen_US
dc.contributor.authorHung, WMen_US
dc.contributor.authorChan, CCen_US
dc.contributor.authorSze, CKHen_US
dc.contributor.authorChan, OSHen_US
dc.contributor.authorChang, ATen_US
dc.contributor.authorYeung, MWRen_US
dc.date.accessioned2014-07-07T07:08:40Z-
dc.date.available2014-07-07T07:08:40Z-
dc.date.issued2014en_US
dc.identifier.citationRadiotherapy & Oncology, 2014, v. 110 n. 3, p. 377-384en_US
dc.identifier.issn0167-8140-
dc.identifier.urihttp://hdl.handle.net/10722/198477-
dc.description.abstractBackground and purpose: To assess the therapeutic gains and setbacks as we evolved from the 2-dimensional radiotherapy (2DRT) to conformal 3-dimensional (3DRT) and to intensity-modulated (IMRT) era. MATERIALS AND METHODS: 1593 consecutive patients from 1994 to 2010 were retrospectively analyzed. Evolving changes in the different era included advances in staging investigation, radiotherapy technique, dose escalation, and use of chemotherapy. RESULTS: The 3DRT era achieved significant improvement in local failure-free rate (L-FFR), disease-specific survival (DSS) and overall survival (OS). Neurological damage and bone/soft tissue necrosis were significantly reduced. However, the improvement in distant failure-free rate (D-FFR) was insignificant, and more hearing impairment occurred due to chemotherapy. Significantly higher D-FFR was achieved in the IMRT era, but L-FFR did not show further improvement. 5-Year DSS increased from 78% in the 2DRT, to 81% in the 3DRT, and 85% in the IMRT era, while the corresponding neurological toxicity rate decreased from 7.4% to 3.5% and 1.8%. CONCLUSIONS: Significant improvement in survival and reduction of serious toxicity was achieved as we evolved from 2DRT to 3DRT and IMRT era; the therapeutic ratio for all T-categories improved with more conformal techniques. Improvements in tumor control were attributed not only to advances in RT technique, but also to better imaging and increasing use of potent chemotherapy. However, it should also be noted that hearing impairment significantly increased due to chemotherapy, L-FFR reached a plateau in the 3DRT era, and it is worrisome that the result for T4 remained unsatisfactory. Besides exploring for more potent chemotherapy and innovative methods, the guideline on dose constraint should be re-visited to optimize the therapeutic ratio.en_US
dc.languageengen_US
dc.publisherElsevier Ireland Ltd.en_US
dc.relation.ispartofRadiotherapy & Oncologyen_US
dc.subjectEfficacy-
dc.subjectLate toxicity-
dc.subjectNasopharyngeal carcinoma-
dc.subjectRadiotherapy-
dc.subjectChemotherapy-
dc.titleEvolution of treatment for nasopharyngeal cancer--success and setback in the intensity-modulated radiotherapy eraen_US
dc.typeArticleen_US
dc.identifier.emailLee, AWM: awmlee@hkucc.hku.hken_US
dc.identifier.emailNg, WT: ngwt1@hkucc.hku.hken_US
dc.identifier.emailSze, CKH: henrysze@graduate.hku.hken_US
dc.identifier.emailChan, OSH: chansh2@hku.hken_US
dc.identifier.emailYeung, MWR: yeungmwr@hkucc.hku.hken_US
dc.identifier.authoritySze, CKH=rp01697en_US
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1016/j.radonc.2014.02.003-
dc.identifier.pmid24630534-
dc.identifier.scopuseid_2-s2.0-84899566552-
dc.identifier.hkuros229835en_US
dc.identifier.volume110en_US
dc.identifier.spage377en_US
dc.identifier.epage384en_US

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