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Article: The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT

TitleThe impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT
Authors
KeywordsNasopharyngeal carcinoma
IMRT
Dosimetry
Dose specification
Organ at risk
Issue Date2014
Citation
Oral Oncology, 2014, v. 50, n. 5, p. 506-512 How to Cite?
AbstractBackground and Purpose This study aims to address the relationship between tumor size and dosimetric inadequacy in treating nasopharyngeal carcinoma (NPC), and how it subsequently affects the local control. Material and Methods 444 NPC patients treated with IMRT from 2005 to 2010 were included in the study. The planning aim was to deliver at least 66.5 Gy (i.e. 95% of 70 Gy) to 95% of the primary gross tumor volume (GTV-P) while keeping all the critical neurological organs at risk (OAR) within dose tolerance. Treatment outcome were analyzed according to T stage, GTV-P volume and the degree of under-dosing. Results Disease outcome was related to T stage, GTV-P volume and the degree of under-dosing. The 5-year local failure free survival (LFFS), disease free survival (DFS) and overall survival (OS) for T4 disease were 74%, 50.4% and 63.6% respectively. 48 cm3 was identified as the critical cut-off GTV-P volume, the large volume group (GTV-P ≥ 48 cm3) had lower 5-year DFS (50.4% vs. 76.6%) and OS (65.2% vs. 86.3%, p < 0.001). Most T4 diseases (and some T3) were under-dosed (<66.5 Gy) and an under-dosed GTV-P volume of 3.4 cm3 was found to be prognostically important. Multivariate analyses showed that the effect of GTV-P volume on LFFR and DFS was outweighed by the degree of under-dosing. Conclusions Treatment outcome of locally advanced NPC was significantly affected by the volume of under-dosed (<66.5 Gy) GTV-P due to the neighboring neurological structures. A new set of OAR dose constraint and specification is proposed. © 2014 Elsevier Ltd. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/213862
ISSN
2015 Impact Factor: 4.286
2015 SCImago Journal Rankings: 1.764

 

DC FieldValueLanguage
dc.contributor.authorNg, Wai Tong-
dc.contributor.authorLee, Michael C H-
dc.contributor.authorChang, Amy T Y-
dc.contributor.authorChan, Oscar S H-
dc.contributor.authorChan, Lucy L K-
dc.contributor.authorCheung, Foon Yiu-
dc.contributor.authorHung, Wai Man-
dc.contributor.authorChan, Connie C C-
dc.contributor.authorLee, Anne W M-
dc.date.accessioned2015-08-19T13:41:00Z-
dc.date.available2015-08-19T13:41:00Z-
dc.date.issued2014-
dc.identifier.citationOral Oncology, 2014, v. 50, n. 5, p. 506-512-
dc.identifier.issn1368-8375-
dc.identifier.urihttp://hdl.handle.net/10722/213862-
dc.description.abstractBackground and Purpose This study aims to address the relationship between tumor size and dosimetric inadequacy in treating nasopharyngeal carcinoma (NPC), and how it subsequently affects the local control. Material and Methods 444 NPC patients treated with IMRT from 2005 to 2010 were included in the study. The planning aim was to deliver at least 66.5 Gy (i.e. 95% of 70 Gy) to 95% of the primary gross tumor volume (GTV-P) while keeping all the critical neurological organs at risk (OAR) within dose tolerance. Treatment outcome were analyzed according to T stage, GTV-P volume and the degree of under-dosing. Results Disease outcome was related to T stage, GTV-P volume and the degree of under-dosing. The 5-year local failure free survival (LFFS), disease free survival (DFS) and overall survival (OS) for T4 disease were 74%, 50.4% and 63.6% respectively. 48 cm3 was identified as the critical cut-off GTV-P volume, the large volume group (GTV-P ≥ 48 cm3) had lower 5-year DFS (50.4% vs. 76.6%) and OS (65.2% vs. 86.3%, p < 0.001). Most T4 diseases (and some T3) were under-dosed (<66.5 Gy) and an under-dosed GTV-P volume of 3.4 cm3 was found to be prognostically important. Multivariate analyses showed that the effect of GTV-P volume on LFFR and DFS was outweighed by the degree of under-dosing. Conclusions Treatment outcome of locally advanced NPC was significantly affected by the volume of under-dosed (<66.5 Gy) GTV-P due to the neighboring neurological structures. A new set of OAR dose constraint and specification is proposed. © 2014 Elsevier Ltd. All rights reserved.-
dc.languageeng-
dc.relation.ispartofOral Oncology-
dc.subjectNasopharyngeal carcinoma-
dc.subjectIMRT-
dc.subjectDosimetry-
dc.subjectDose specification-
dc.subjectOrgan at risk-
dc.titleThe impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.oraloncology.2014.01.017-
dc.identifier.pmid24529762-
dc.identifier.scopuseid_2-s2.0-84899062187-
dc.identifier.hkuros266375-
dc.identifier.volume50-
dc.identifier.issue5-
dc.identifier.spage506-
dc.identifier.epage512-
dc.identifier.eissn1879-0593-

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