nach oben

Erschienen in:

08.09.2017 | Original Article

Clinical outcomes of concurrent chemoradiotherapy with volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma

verfasst von: Nobuki Imano, Yuji Murakami, Takeo Nakashima, Yuki Takeuchi, Ippei Takahashi, Yoshiko Doi, Ikuno Nishibuchi, Tomoki Kimura, Koichi Wadasaki, Tsutomu Ueda, Katsuhiro Hirakawa, Yasushi Nagata

Erschienen in: Japanese Journal of Radiology | Ausgabe 11/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study was to analyze the clinical results of concurrent chemoradiotherapy (CCRT) with volumetric modulated arc therapy (VMAT) for nasopharyngeal carcinoma (NPC) patients.

Materials and methods

Patients with stage II–IVB NPC who received CCRT with VMAT between 2010 and 2014 were included in this study. The planned dose was 70 Gy in 35 fractions.

Results

Twenty patients aged between 28 and 85 years (median 60 years) were assessed. With a median follow-up time of 47 months, the 3-year overall survival and progression-free survival rates were 85 and 65%, respectively. The 3-year local, regional and distant control rates were 78, 88 and 79%, respectively. At 0, 3, 6 and 12 months from CCRT, 19, 6, 3, and 1 patients had grade 2 dry mouth, respectively. No cases of grade 3 or worse dry mouth were observed. The severity of dry mouth was downgraded from grade 2 to grade 0 or 1 significantly earlier in younger patients (<70 years, p = 0.02) or patients in whom the mean dose to one parotid gland was lower (<26 Gy, p = 0.04).

Conclusions

Our clinical results regarding CCRT with VMAT for NPC patients showed favorable survival rates while maintaining organ function.

Tham IW, Hee SW, Yeo RM, Salleh PB, Lee J, Tan TW, et al. Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy—the National Cancer Centre Singapore experience. Int J Radiat Oncol Biol Phys. 2009;75:1481–6.CrossRefPubMed

Lee N, Xia P, Quivey JM, Sultanem K, Poon I, Akazawa C, et al. 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.CrossRefPubMed

Kam MK, Teo PM, Chau RM, Cheung KY, Choi PH, Kwan WH, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys. 2004;60:1440–50.CrossRefPubMed

Nishimura Y, Shibata T, Nakamatsu K, Kanamori S, Koike R, Okubo M, et al. A two-step intensity-modulated radiation therapy method for nasopharyngeal cancer: the Kinki University experience. Jpn J Clin Oncol. 2010;40:130–8.CrossRefPubMed

Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66:981–91.CrossRefPubMed

Kam MK, Leung SF, Zee B, Chau RM, Suen JJ, Mo F, et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol. 2007;25:4873–9.CrossRefPubMed

Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12:127–36.CrossRefPubMedPubMedCentral

Verbakel WF, Cuijpers JP, Hoffmans D, Bieker M, Slotman BJ, Senan S. Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys. 2009;74:252–9.CrossRefPubMed

Doornaert P, Verbakel WF, Bieker M, Slotman BJ, Senan S. RapidArc planning and delivery in patients with locally advanced head-and-neck cancer undergoing chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2011;79:429–35.CrossRefPubMed

10.

Gomez-Millan Barrachina J, Jerez Sainz I, Perez Rozos A, Ramirez Ros JC, Toledo Serrano MD, Lupiañez Perez Y, et al. Potential advantages of volumetric arc therapy in head and neck cancer. Head Neck. 2015;37:909–14.CrossRefPubMed

11.

Broggi Sara, Perna Lucia, Bonsignore Francesco, Rinaldin Giuseppe, Fiorino Claudio, Chiara Anna, et al. Static and rotational intensity modulated techniques for head-neck cancer radiotherapy: a planning comparison. Phys Med. 2014;30:973–9.CrossRefPubMed

12.

Anamalayil SJ, Teo BK, Lin A, Lustig RA, Ahn PH. Effects of full-neck volumetric-modulated arc therapy vs split-field intensity-modulated head and neck radiation therapy on low neck targets and structures. Br J Radiol. 2016;89:1062.CrossRef

13.

Dai X, Zhao Y, Liang Z, Dassarath M, Wang L, Jin L, et al. Volumetric-modulated arc therapy for oropharyngeal carcinoma: a dosimetric and delivery efficiency comparison with static-field IMRT. Phys Med. 2015;31:54–9.CrossRefPubMed

14.

Holt A, Van Gestel D, Arends MP, Korevaar EW, Schuring D, Kunze-Busch MC, et al. Multi-institutional comparison of volumetric modulated arc therapy vs. intensity-modulated radiation therapy for head-and-neck cancer: a planning study. Radiat Oncol. 2013; 8:26.CrossRefPubMedPubMedCentral

15.

Guo R, Tang LL, Mao YP, Zhou GQ, Qi ZY, Liu LZ, et al. Clinical outcomes of volume-modulated arc therapy in 205 patients with nasopharyngeal carcinoma: an analysis of survival and treatment toxicities. PLoS One. 2015;10:e0129679.CrossRefPubMedPubMedCentral

16.

Grégoire V, Levendag P, Ang KK, Bernier J, Braaksma M, Budach V, et al. CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol. 2003;69:227–36.CrossRefPubMed

17.

Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16:1310–7.CrossRefPubMed

18.

Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003;21:631–7.CrossRefPubMed

19.

Chen Y, Liu MZ, Liang SB, Zong JF, Mao YP, Tang LL, et al. Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of China. Int J Radiat Oncol Biol Phys. 2008;71:1356–64.CrossRefPubMed

20.

Chen Y, Sun Y, Liang SB, Zong JF, Li WF, Chen M, et al. Progress report of a randomized trial comparing long-term survival and late toxicity of concurrent chemoradiotherapy with adjuvant chemotherapy versus radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China. Cancer. 2013;119:2230–8.CrossRefPubMed

21.

Lee AW, Lau WH, Tung SY, Chua DT, Chappell R, Xu L, et al. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol. 2005;23:6966–75.CrossRefPubMed

22.

Wolden SL, Chen WC, Pfister DG, Kraus DH, Berry SL, Zelefsky MJ. Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys. 2006;64:57–62.CrossRefPubMed

23.

Lee N, Harris J, Garden AS, Straube W, Glisson B, Xia P, et al. Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. J Clin Oncol. 2009;27:3684–90.CrossRefPubMedPubMedCentral

24.

Reddy SP, Raslan WF, Gooneratne S, Kathuria S, Marks JE. Prognostic significance of keratinization in nasopharyngeal carcinoma. Am J Otolaryngol. 1995;16:103–8.CrossRefPubMed

25.

Chua DT, Sham JS, Wei WI, Ho WK, Au GK. The predictive value of the 1997 American Joint Committee on Cancer stage classification in determining failure patterns in nasopharyngeal carcinoma. Cancer. 2001;92:2845–55.CrossRefPubMed

26.

Chang CC, Chen MK, Liu MT, Wu HK. The effect of primary tumor volumes in advanced T-staged nasopharyngeal tumors. Head Neck. 2002;24:940–6.CrossRefPubMed

27.

Cannon DM, Lee NY. Recurrence in region of spared parotid gland after definitive intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;70:660–5.CrossRefPubMed

28.

Schoenfeld GO, Amdur RJ, Morris CG, Li JG, Hinerman RW, Mendenhall WM. Patterns of failure and toxicity after intensity modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;71:377–85.CrossRefPubMed

29.

Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;45:577–87.CrossRefPubMed

30.

Hey J, Setz J, Gerlach R, Janich M, Hildebrandt G, Vordermark D, et al. Parotid gland-recovery after radiotherapy in the head and neck region—36 months follow-up of a prospective clinical study. Radiat Oncol. 2011;6:125.CrossRefPubMedPubMedCentral

Titel: Clinical outcomes of concurrent chemoradiotherapy with volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma
verfasst von: Nobuki Imano
Yuji Murakami
Takeo Nakashima
Yuki Takeuchi
Ippei Takahashi
Yoshiko Doi
Ikuno Nishibuchi
Tomoki Kimura
Koichi Wadasaki
Tsutomu Ueda
Katsuhiro Hirakawa
Yasushi Nagata
Publikationsdatum: 08.09.2017
Verlag: Springer Japan
Erschienen in: Japanese Journal of Radiology / Ausgabe 11/2017
Print ISSN: 1867-1071
Elektronische ISSN: 1867-108X
DOI: https://doi.org/10.1007/s11604-017-0680-5

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Clinical outcomes of concurrent chemoradiotherapy with volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma