Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma
Identifieur interne : 000715 ( Pmc/Checkpoint ); précédent : 000714; suivant : 000716Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma
Auteurs : Ki Ho Seol [Corée du Sud] ; Jeong Eun Lee [Corée du Sud]Source :
- Radiation Oncology Journal [ 2234-1900 ] ; 2016.
Abstract
To evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC).
Fifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4–72 Gy (39.6–45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed.
The median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively.
No patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.
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DOI: 10.3857/roj.2016.34.1.10
PubMed: 27104162
PubMed Central: 4831964
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma</title><author><name sortKey="Seol, Ki Ho" sort="Seol, Ki Ho" uniqKey="Seol K" first="Ki Ho" last="Seol">Ki Ho Seol</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu</wicri:regionArea><wicri:noRegion>Daegu</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Jeong Eun" sort="Lee, Jeong Eun" uniqKey="Lee J" first="Jeong Eun" last="Lee">Jeong Eun Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu</wicri:regionArea><wicri:noRegion>Daegu</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27104162</idno><idno type="pmc">4831964</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831964</idno><idno type="RBID">PMC:4831964</idno><idno type="doi">10.3857/roj.2016.34.1.10</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000849</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000849</idno><idno type="wicri:Area/Pmc/Curation">000849</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000849</idno><idno type="wicri:Area/Pmc/Checkpoint">000715</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000715</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma</title><author><name sortKey="Seol, Ki Ho" sort="Seol, Ki Ho" uniqKey="Seol K" first="Ki Ho" last="Seol">Ki Ho Seol</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu</wicri:regionArea><wicri:noRegion>Daegu</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Jeong Eun" sort="Lee, Jeong Eun" uniqKey="Lee J" first="Jeong Eun" last="Lee">Jeong Eun Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu</wicri:regionArea><wicri:noRegion>Daegu</wicri:noRegion></affiliation></author></analytic><series><title level="j">Radiation Oncology Journal</title><idno type="ISSN">2234-1900</idno><idno type="eISSN">2234-3164</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>To evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC).</p></sec><sec><title>Materials and Methods</title><p>Fifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4–72 Gy (39.6–45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed.</p></sec><sec><title>Results</title><p>The median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively.</p></sec><sec><title>Conclusion</title><p>No patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Sham, Js" uniqKey="Sham J">JS Sham</name></author><author><name sortKey="Choy, D" uniqKey="Choy D">D Choy</name></author><author><name sortKey="Wei, Wi" uniqKey="Wei W">WI Wei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tang, L" uniqKey="Tang L">L Tang</name></author><author><name sortKey="Mao, Y" uniqKey="Mao Y">Y Mao</name></author><author><name sortKey="Liu, L" uniqKey="Liu L">L Liu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ho, Fc" uniqKey="Ho F">FC Ho</name></author><author><name sortKey="Tham, Iw" uniqKey="Tham I">IW Tham</name></author><author><name sortKey="Earnest, A" uniqKey="Earnest A">A Earnest</name></author><author><name sortKey="Lee, Km" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Radiat Oncol J</journal-id><journal-id journal-id-type="iso-abbrev">Radiat Oncol J</journal-id><journal-id journal-id-type="publisher-id">ROJ</journal-id><journal-title-group><journal-title>Radiation Oncology Journal</journal-title></journal-title-group><issn pub-type="ppub">2234-1900</issn><issn pub-type="epub">2234-3164</issn><publisher><publisher-name>The Korean Society for Radiation Oncology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27104162</article-id><article-id pub-id-type="pmc">4831964</article-id><article-id pub-id-type="doi">10.3857/roj.2016.34.1.10</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject><subj-group subj-group-type="subheading"><subject>Clinical Investigation</subject></subj-group></subj-group></article-categories><title-group><article-title>Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Seol</surname><given-names>Ki Ho</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Lee</surname><given-names>Jeong Eun</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1"></xref></contrib></contrib-group><aff id="A1">Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.</aff><author-notes><corresp>Correspondence: Jeong Eun Lee, MD, Department of Radiation Oncology, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-420-5353, Fax: +82-53-426-3303, <email>jelee@knu.ac.kr</email></corresp></author-notes><pub-date pub-type="ppub"><month>3</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>30</day><month>3</month><year>2016</year></pub-date><volume>34</volume><issue>1</issue><fpage>10</fpage><lpage>17</lpage><history><date date-type="received"><day>13</day><month>1</month><year>2016</year></date><date date-type="rev-recd"><day>21</day><month>2</month><year>2016</year></date><date date-type="accepted"><day>15</day><month>3</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016. The Korean Society for Radiation Oncology</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Purpose</title><p>To evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC).</p></sec><sec><title>Materials and Methods</title><p>Fifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4–72 Gy (39.6–45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed.</p></sec><sec><title>Results</title><p>The median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively.</p></sec><sec><title>Conclusion</title><p>No patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.</p></sec></abstract><kwd-group><kwd>Nasopharyngeal carcinoma</kwd><kwd>Lymphatic Irradiation</kwd><kwd>Treatment failure</kwd></kwd-group><funding-group><award-group><funding-source country="KR"><institution-wrap><institution>Kyungpook National University</institution><institution-id institution-id-type="CrossRef">http://dx.doi.org/10.13039/501100002531</institution-id></institution-wrap></funding-source></award-group></funding-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><title>An example of the tailored elective neck nodal irradiation (ENI) for a patient with cT3N1 nasopharyngeal carcinoma. The beam's-eye-view display with a digitally reconstructed radiograph shows the clinical target volume (red) including an electively irradiated nodal area for a dose of 4,950 cGy. The green shows the cricoid cartilage. On the side without nodal involvement (except retropharyngeal node), ENI included only RPN, levels II, III, and Va. ENI did not routinely include the level I region.</title></caption><graphic xlink:href="roj-34-10-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><title>Patterns of failure.</title></caption><graphic xlink:href="roj-34-10-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><title>Kaplan-Meier curves of (A) locoregional control, (B) 3-year distant failure-free, (C) 3-year overall survival, and (D) 3-year disease-free survival rates.</title></caption><graphic xlink:href="roj-34-10-g003"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Patient and tumor characteristics (n = 56)</title></caption><graphic xlink:href="roj-34-10-i001"></graphic><table-wrap-foot><fn><p>CCRT, concurrent chemoradiotherapy; IMRT, intensity modulated radiotherapy; 3D-CRT, three-dimensional conformal radiotherapy.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><title>Patterns of nodal failure (n = 3)</title></caption><graphic xlink:href="roj-34-10-i002"></graphic><table-wrap-foot><fn><p>ENI, elective neck nodal irradiation.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Corée du Sud</li></country></list><tree><country name="Corée du Sud"><noRegion><name sortKey="Seol, Ki Ho" sort="Seol, Ki Ho" uniqKey="Seol K" first="Ki Ho" last="Seol">Ki Ho Seol</name></noRegion><name sortKey="Lee, Jeong Eun" sort="Lee, Jeong Eun" uniqKey="Lee J" first="Jeong Eun" last="Lee">Jeong Eun Lee</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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