Local failure patterns for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy

Radiation Oncology

Tai-xiang Lu³  Bi-xiu Wen²  Shuai Liu³  Fei Han³  Bin Ouyang²  Xin-hua Jiang¹  Shao-min Huang³  Jia-xin Li² 

[1] Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-Sen University, and State Key Laboratory of Oncology in Southern China, 651 Dongfeng Road East, Guangzhou 510060, P.R. China;Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road II, Guangzhou 510080, P.R. China;Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, and State Key Laboratory of Oncology in Southern China, 651 Dongfeng Road East, Guangzhou 510060, P.R. China

关键词: Treatment failure;    Intensity-modulated;    Radiotherapy;    Radiometry;    Local;    Neoplasm recurrence;    Nasopharyngeal carcinoma;   

Others  :  810464
DOI  :  10.1186/1748-717X-9-87

 received in 2013-11-15, accepted in 2014-03-09,  发布年份 2014

【 摘 要 】

Background

To investigate the clinical feature and the local failure patterns after intensity-modulated radiotherapy for nasopharyngeal carcinoma.

Methods

Between March 2007 and July 2009, 710 patients with nasopharyngeal carcinoma were treated with intensity-modulated radiotherapy. The magnetic resonance imagings obtained at recurrence were registered with the original planning computed tomography for dosimetry analysis.

Results

With a median follow-up of 38 months, 34 patients have developed local recurrence (32 cases valid). The incidence of invasion to nasopharynx, parapharyngeal space and the retropharyngeal space by the primary tumors was 100%, 75.0% and 62.5%, respectively, but 78.1%, 34.4% and 21.9% at recurrence, respectively. The rate of invasion to ethmoid sinus was 3.1% by the primary tumors but 28.1% at recurrence (p = 0.005). The topographic analysis of the local failure patterns showed "central" in 16 patients; "marginal" in 9; and "outside" in 7. The median volumes of primary gross tumor were 45.84 cm³ in the central failure group, 29.44 cm³ in the marginal failure group, and 21.52 cm³ in the outside failure group, respectively (p = 0.012), and the median volumes of primary clinical target1 were 87.28 cm³, 61.90 cm³ and 58.74 cm³ in the three groups, respectively (p = 0.033).

Conclusions

In patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy, the recurrent tumors had their unique characteristic and regularity of invasion to adjacent structures. "Central" failure was the major local failure pattern. The volumes of primary gross tumor and clinical target1 were significantly correlated with recurrent patterns. Employ more aggressive approaches to tumor cells which will be insensitive to radiotherapy may be an effective way to reduce the central failure.

【 授权许可】

   
2014 Li et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Lee AW, Sez WM, Au JS, Leung SF, Leung TW, Chua DT, Zee BC, Law SC, Teo PM, Tung SY, Kwong DL, Lau WH: Treatment results for nasopharyngeal carcinoma in the modern era: the Hongkong experience. Int J Radiat Oncol Biol Phys 2005, 61:1107-1116.
• [2]Leung TW, Tung SY, Sze WK, Wong FC, Yuen KK, Lui CM, Lo SH, Ng TY, Saiki O: Treatment results of 1070 patients with nasopharyngeal carcinoma: an analysis of survival and failure patterns. Head Neck 2005, 27:555-565.
• [3]Yi JL, Gao L, Huan XD, Li SY, Luo JW, Cai WM, Xiao JP, Xu GZ: Nasopharyngeal carcinoma treated by radical radiotherapy alone: ten-year experience of a single institution. Int J Radiat Oncol Biol Phys 2006, 65:161-168.
• [4]Teo PM, Leung SF, Tung SY, Zee B, Sham JS, Lee AW, Lau WH, Kwan WH, Leung TW, Chua D, Sze WM, Au JS, Yu KH, Saiki O, Kwong D, Yau TK, Law SC, Sze WK, Au G, Chan AT: Dose–response relationship of nasopharyngeal carcinoma above conventional tumoricidal level: a study by the Hong Kong Nasopharyngeal Carcinoma Study Group (HKNPCSG). Radiother Oncol 2006, 79:27-33.
• [5]Xia P, Fu KK, Wong GW, Akazawa C, Verhey LJ: Comparison of treatment plans involving intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000, 48:329-337.
• [6]Kam MK, Chau RM, Suen J, Choi PH, Teo PM: Intensity-modulated radiotherapy in nasopharyngeal carcinoma: dosimetric advantage over conventional plans and feasibility of dose escalation. Int J Radiat Oncol Biol Phys 2003, 56:145-157.
• [7]Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, Akazawa P, Weinberg V, Fu KK: Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 2002, 53:12-22.
• [8]Lin S, Pan J, Han L, Zhang X, Liao X, Lu JJ: Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys 2009, 75:1071-1078.
• [9]Tham IW, Hee SW, Yeo RM, Salleh PB, Lee J, Tan TW, Fong KW, Chua ET, Wee JT: Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy-the national cancer centre singapore experience. Int J Radiat Oncol Biol Phys 2009, 75:1481-1486.
• [10]Sobin LH, Gospodaroeics MK, Wittekind C: TNM Classification of malignant tumours. 7th edition. New York: Wiley Press; 2009.
• [11]Xiao WW, Huang SM, Han F, Wu SX, Lu LX, Lin CG, Deng XW, Lu TX, Cui NJ, Zhao C: Local control, survival, and late toxicities of locally advanced nasopharyngeal carcinoma treated by simultaneous modulated accelerated radiotherapy combined with cisplatin concurrent chemotherapy: long-term results of a phase 2 study. Cancer 2011, 117:1874-1883.
• [12]Kessler ML, Pitluck S, Petti PL, Castro JR: Integration of multimodality imaging data for radiotherapy treatment planning. Int J Radiat Oncol Biol Phys 1991, 21:1653-1667.
• [13]Ten Haken RK, Thornton AF, Sandler HM, LaVigne ML, Quint DJ, Fraass BA, Kessler ML, McShan DL: A quantitative assessment of the addition of MRI to CT-based, 3-D treatment planning of brain tumors. Radiother Oncol 1992, 25:121-133.
• [14]Chao KS, Perez CA: Nasopharynx. In Principles and practice of radiation oncology. 4th edition. Edited by Perez C, Brady L, Halperin E, Schmidt-Ullrich R. Philadelphia: Lippincott Williams & Wilkins; 2003:930.
• [15]Lee N, Harris J, Garden AS, Straube W, Glisson B, Xia P, Bosch W, Morrison WH, Quivey J, Thorstad W, Jones C, Ang KK: Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. J Clin Oncol 2009, 27:3684-3690.
• [16]Lee NY, Zhang Q, Pfister DG, Kim J, Garden AS, Mechalakos J, Hu K, Le QT, Colevas AD, Glisson BS, Chan AT, Ang KK: Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. Lancet Oncol 2012, 13:172-180.
• [17]Levine HL: Functional endoscopic sinus surgery: evaluation surgery and follow-up of 250 patients. Laryngoscope 1990, 100:79-84.
• [18]Oksuz DC, Prestwich RJ, Carey B, Wilson S, Senocak MS, Choudhury A, Dyker K, Coyle C, Sen M: Recurrence patterns of locally advanced head and neck squamous cell carcinoma after 3D conformal (chemo)-radiotherapy. Radiat Oncol 2011, 6:54. BioMed Central Full Text
• [19]Chao KS, Ozyigit G, Tran BN, Cengiz M, Dempsey JF, Low DA: Patterns of failure in patients receiving definitive and postoperative IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2003, 55:312-321.
• [20]Studer G, Luetolf UM, Glanzmann C: Locoregional failure analysis in head-and-neck cancer patients treated with IMRT. Strahlenther Oncol 2007, 183:417-423.
• [21]Ng WT, Lee MC, Hung WM, Choi CW, Lee KC, Chan OS, Lee AW: Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2011, 79:420-428.
• [22]Shen C, Lu JJ, Gu Y, Zhu G, Hu C, He S: Prognostic impact of primary tumor volume in patients with nasopharyngeal carcinoma treated by definitive radiation therapy. Laryngoscope 2008, 118:1206-1210.
• [23]Chua DT, Sham JS, Kwong DL, Tai KS, Wu PM, Lo M, Yung A, Choy D, Leong L: Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome. Int J Radiat Oncol Biol Phys 1997, 39:71l-719.
• [24]Fletcher GH, Million RR: Nasopharynx. In Textbook of radiotherapy. 3rd edition. Edited by Fletcher GH. Philadelphia: Lea & Febiger Press; 1980:364-383.
• [25]Stanley JA, Shipley WU, Steel GG: Influence of tumor size on hyopxic fraction and therapeutic sensitivity of Lewis lung tumor. Br J Cancer 1977, 36:105-113.
• [26]Hall EJ: Radiobiology for the radiologist. Philadelphia: JB Lippincott Press; 1994.
• [27]Lee NY, Mechalakos JG, Nehmeh S, Lin Z, Squire OD, Cai S, Chan K, Zanzonico PB, Greco C, Ling CC, Humm JL, Schöder H: Fluorine-18-labeled fluoromisonidazole positron emission and computed tomography-guided intensity-modulated radiotherapy for head and neck cancer: a feasibility study. Int J Radiat Oncol Biol Phys 2008, 70:2-13.
• [28]Grosu AL, Souvatzoglou M, Röper B, Dobritz M, Wiedenmann N, Jacob V, Wester HJ, Reischl G, Machulla HJ, Schwaiger M, Molls M, Piert M: Hypoxia imaging with FAZA-PET and theoretical considerations with regard to dose painting for individualization of radiotherapy in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 2007, 69:541-551.
• [29]Wong TZ, Lacy JL, Petry NA, Hawk TC, Sporn TA, Dewhirst MW, Vlahovic G: PET of hypoxia and perfusion with 62Cu-ATSM and 62Cu-PTSM using a 62Zn/62Cu generator. AJR Am J Roentgenol 2008, 190:427-432.
• [30]Overgaard J: Clinical evaluation of nitromidazoles as modifiers of hypoxia in solid tumors. Oncol Res 1994, 6:509-518.
• [31]Overgaard J, Hansen HS, Overgaard M, Bastholt L, Berthelsen A, Specht L, Lindeløv B, Jørgensen K: A randomized double-blind phase III study of nimorazole as a hypoxic radiosensitizer of primary radiotherapy in supraglottic larynx and pharynx carcinoma. Results of the Danish Head and Neck Cancer Study (DAHANCA) Protocol 5–85. Radiother Oncol 1998, 46:135-146.
• [32]Capelle L, Mackenzie M, Field C, Parliament M, Ghosh S, Scrimger R: Adaptive radiotherapy using helical tomotherapy for head and neck cancer in definitive and postoperative settings: initial results. Clin Oncol (R Coll Radiol) 2012, 24:208-215.