Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma
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hen1 · Y.-S. Huang2 · S-H. Kuo1, 3 · Y.-F. Chen2 · R.-L. Hong4 · J.-Y. Ko5 · P.-J. Lou5 · C.-L. Tsai1 · W.-Y. Chen1 · C.-W. Wang1 1 Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 2 Department of Medical Imaging, National Taiwan University Hospital, Taipei 3 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 4 Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 5 Department of Otolaryngology, National Taiwan University Hospital, Taipei
Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma Treatment results and locoregional recurrence
Nasopharyngeal carcinoma (NPC) is a highly radiosensitive and chemosensitive tumor, and concurrent chemoradiotherapy (CCRT) is the standard treatment for patients with locally advanced disease [1, 2]. However, locoregional control (LRC) remains poor especially for tumors with intracranial extension and/or initially high local tumor burden [3, 4], including those with cranial nerve, infratemporal fossa, orbit, hypopharynx, or masticator space involvement, categorized as T4 disease according to the American Joint Commission on Cancer (AJCC) [5]. T4 disease is considered as a significant barrier to achieving successful treatment because of the proximity of a T4 tumor to critical neural structures, which prevents good radiation field coverage and necessitates dose reductions for critical organ tolerance. Intensity-modulated radiation therapy (IMRT) can achieve better dose differentiation between tumorous and normal tissues than two-dimensional or three-dimensional (3D) conformal radiotherapy and facilitates simultaneous delivery of different fractional doses to different targets [6, 7]. In all stages of nonmetastatic NPC, IMRT has the advantage of better tumor coverage because it allows room for dose escalation, while reducing exposure to the parotid gland, temporomandibular joints, and brainstem/temporal lobe [7].
Thus, IMRT is expected to be beneficial for T4 NPC, as a way to increase the biologic effect on the tumor by physical dose escalation or accelerated fractionation, while avoiding toxicity to critical tissues. Little data specifically addresses the treatment outcome and failure patterns of T4 NPC patients treated with IMRT. Here, we report on survival and LRC observed after IMRT to treat T4 NPC patients. The survival and feasibility of salvage treatment for locoregional recurrence after definitive IMRT was analyzed to provide a reference for clinical management.
Materials and methods Patients The study was approved by the Institutional Review Board of our institute (201211028RIC). The records of patients treated consecutively with curative IMRT for non-metastatic NPC at our institution between January 2007 and October 2010 were reviewed. Only patients with T4 disease were included. Subsite localization of the nasopharynx tumor was categorized according to the 6th edition of the AJCC staging criteria [5] as intracranial ex
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