Using neoadjuvant chemotherapy and replanning intensity-modulated radiotherapy for nasopharyngeal carcinoma with intracranial invasion to protect critical normal tissue

Radiation Oncology

Lin Kong¹  Chaosu Hu¹  Yunsheng Gao¹  Xi Chang¹  Xiaoshuang Niu¹ 

[1] Department of Radiation Oncology, Shanghai Cancer Center of Fudan University, 270 Dong’an Road, Shanghai 200032, China

关键词: Comprehensive treatment;    Replanning IMRT;    Nasopharyngeal carcinoma;   

Others  :  1152867
DOI  :  10.1186/1748-717X-8-226

 received in 2013-04-04, accepted in 2013-09-28,  发布年份 2013

【 摘 要 】

Purpose

To investigate the feasibility of neoadjuvant chemotherapy and replanning intensity-modulated radiotherapy (IMRT) for intracranial invasion nasopharyngeal carcinoma (NPC).

Methods and materials

From June 2007 to January 2012, 32 patients with intracranial invasion NPC treated with TPF (docetaxel 75 mg/m2, cisplatin 75 mg/m2, 5-FU 2500 mg/m2 every 3 weeks for 3 cycles) neoadjuvant chemotherapy, and replanning IMRT with concurrent chemotherapy were retrospectively studied. The first IMRT plan for each patient was generated based on the original planning CT scan acquired before the start of treatment. Because of tumor shrinkage during radiotherapy, modified gross tumor volume of primary tumor (GTV-P) and high risk clinical target volume (CTV-H), and a new plan was generated and used to complete the course of IMRT. The DVHs of IMRT plan with or without replanning were compared.

Results

There weren’t statistically significant differences in the V95, D-mean, D-95, and D-99 to the modified PTV_GTV-P and PTV_CTV-H with and without replanning IMRT. Replanning reduced the doses to the brain stem, optic nerve, optic chiasm and temporal lobe. Objective responses were 100.0% 3 months after completion of radiotherapy. Acute toxicities were well tolerated, except for the relatively high incidence of neutropenia. The 2-year local control rates and distant-metastasis free survival were 88.2% (95% CI, 72.9% to 100.0%) and 89.6% (95% CI, 75.9% to 100.0%).

Conclusion

Neoadjuvant chemotherapy and replanning IMRT according to tumor shrinkage during the treatment is essential to ensure safe doses to normal tissues, and produces encouraging outcome for intracranial invasion NPC.

【 授权许可】

   
2013 Niu et al.; licensee BioMed Central Ltd.

【 图 表 】

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