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Article: Radiation-induced hypoglossal nerve palsy after definitive radiotherapy for nasopharyngeal carcinoma: Clinical predictors and dose–toxicity relationship

TitleRadiation-induced hypoglossal nerve palsy after definitive radiotherapy for nasopharyngeal carcinoma: Clinical predictors and dose–toxicity relationship
Authors
KeywordsHypoglossal nerve
Nasopharyngeal carcinoma
Intensity-modulated radiotherapy
Radiation dosimetry
Issue Date2019
PublisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/radonc
Citation
Radiotherapy & Oncology, 2019, v. 138, p. 93-98 How to Cite?
AbstractBackground and purpose: Radiation-induced hypoglossal nerve palsy is a debilitating and irreversible late complication after definitive radiotherapy for nasopharyngeal carcinoma (NPC) and other skull base tumors. This study sets to evaluate its incidence and clinical predictive factors, and to propose relevant dosimetric constraints for this structure to guide radiotherapy planning. Materials and methods: We undertook a retrospective review of 797 NPC patients who underwent definitive intensity-modulated radiotherapy (IMRT) between 2003 and 2011. Cumulative incidence and clinical predictors for radiation-induced hypoglossal nerve palsy were evaluated. Archived radiotherapy plans were retrieved and 330 independent hypoglossal nerves were retrospectively contoured following standardized atlas. Optimal threshold analyses of dosimetric parameters (Dmax, D0.5cc, D1cc, D2cc, Dmean) were conducted using receiver operating characteristic curves. Normal tissue complication probability was generated with logistic regression modeling. Results: With a median follow-up of 8.1 years, sixty-nine (8.7%) patients developed radiation-induced hypoglossal nerve palsy. High radiotherapy dose, premorbid diabetes, advanced T-stage and radiological hypoglossal canal involvement were independent clinical risk factors. Maximum dose received by 1 cc volume (D1cc) was the best predictor for the development of radiation-induced nerve palsy (AUC = 0.826) at 8 years after IMRT. Hypoglossal nerves with D1cc of 74 Gy EQD2 had an estimated palsy risk of 4.7%. Nerves with D1cc <74 Gy EQD2 had significantly lower risk of palsy than those ≥74 Gy EQD2 (2.4% vs 20.8%, p <0.001). Conclusion: Incidence of radiation-induced hypoglossal nerve palsy was high after definitive IMRT for NPC. D1cc <74 Gy EQD2 can serve as a useful dose constraint to adopt during radiotherapy planning to limit palsy risk to <5% at 8 years after IMRT.
Persistent Identifierhttp://hdl.handle.net/10722/293332
ISSN
2023 Impact Factor: 4.9
2023 SCImago Journal Rankings: 1.702
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChow, JCH-
dc.contributor.authorCheung, KM-
dc.contributor.authorAu, KH-
dc.contributor.authorZee, BCY-
dc.contributor.authorLee, J-
dc.contributor.authorNgan, KCR-
dc.contributor.authorLee, AWM-
dc.contributor.authorYiu, HHY-
dc.contributor.authorLi, KWS-
dc.contributor.authorLeung, AKC-
dc.contributor.authorChan, JCH-
dc.contributor.authorLee, FKH-
dc.contributor.authorWong, KH-
dc.date.accessioned2020-11-23T08:15:13Z-
dc.date.available2020-11-23T08:15:13Z-
dc.date.issued2019-
dc.identifier.citationRadiotherapy & Oncology, 2019, v. 138, p. 93-98-
dc.identifier.issn0167-8140-
dc.identifier.urihttp://hdl.handle.net/10722/293332-
dc.description.abstractBackground and purpose: Radiation-induced hypoglossal nerve palsy is a debilitating and irreversible late complication after definitive radiotherapy for nasopharyngeal carcinoma (NPC) and other skull base tumors. This study sets to evaluate its incidence and clinical predictive factors, and to propose relevant dosimetric constraints for this structure to guide radiotherapy planning. Materials and methods: We undertook a retrospective review of 797 NPC patients who underwent definitive intensity-modulated radiotherapy (IMRT) between 2003 and 2011. Cumulative incidence and clinical predictors for radiation-induced hypoglossal nerve palsy were evaluated. Archived radiotherapy plans were retrieved and 330 independent hypoglossal nerves were retrospectively contoured following standardized atlas. Optimal threshold analyses of dosimetric parameters (Dmax, D0.5cc, D1cc, D2cc, Dmean) were conducted using receiver operating characteristic curves. Normal tissue complication probability was generated with logistic regression modeling. Results: With a median follow-up of 8.1 years, sixty-nine (8.7%) patients developed radiation-induced hypoglossal nerve palsy. High radiotherapy dose, premorbid diabetes, advanced T-stage and radiological hypoglossal canal involvement were independent clinical risk factors. Maximum dose received by 1 cc volume (D1cc) was the best predictor for the development of radiation-induced nerve palsy (AUC = 0.826) at 8 years after IMRT. Hypoglossal nerves with D1cc of 74 Gy EQD2 had an estimated palsy risk of 4.7%. Nerves with D1cc <74 Gy EQD2 had significantly lower risk of palsy than those ≥74 Gy EQD2 (2.4% vs 20.8%, p <0.001). Conclusion: Incidence of radiation-induced hypoglossal nerve palsy was high after definitive IMRT for NPC. D1cc <74 Gy EQD2 can serve as a useful dose constraint to adopt during radiotherapy planning to limit palsy risk to <5% at 8 years after IMRT.-
dc.languageeng-
dc.publisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/radonc-
dc.relation.ispartofRadiotherapy & Oncology-
dc.subjectHypoglossal nerve-
dc.subjectNasopharyngeal carcinoma-
dc.subjectIntensity-modulated radiotherapy-
dc.subjectRadiation dosimetry-
dc.titleRadiation-induced hypoglossal nerve palsy after definitive radiotherapy for nasopharyngeal carcinoma: Clinical predictors and dose–toxicity relationship-
dc.typeArticle-
dc.identifier.emailNgan, KCR: rkcngan@hku.hk-
dc.identifier.emailLee, AWM: awmlee@hkucc.hku.hk-
dc.identifier.authorityNgan, KCR=rp02371-
dc.identifier.authorityLee, AWM=rp02056-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.radonc.2019.06.011-
dc.identifier.pmid31252300-
dc.identifier.scopuseid_2-s2.0-85067694707-
dc.identifier.hkuros319711-
dc.identifier.volume138-
dc.identifier.spage93-
dc.identifier.epage98-
dc.identifier.isiWOS:000482210600014-
dc.publisher.placeIreland-

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