The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT
Summary Background and Purpose This study aims to address the relationship between tumor size and dosimetric inadequacy in treating nasopharyngeal carcinoma (NPC), and how it subsequently affects the local control. Material and Methods 444 NPC patients treated with IMRT from 2005 to 2010 were includ...
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| Veröffentlicht in: | Oral oncology 2014-05, Vol.50 (5), p.506-512 |
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| creator | Ng, Wai Tong Lee, Michael C.H Chang, Amy T.Y Chan, Oscar S.H Chan, Lucy L.K Cheung, Foon Yiu Hung, Wai Man Chan, Connie C.C Lee, Anne W.M |
| description | Summary Background and Purpose This study aims to address the relationship between tumor size and dosimetric inadequacy in treating nasopharyngeal carcinoma (NPC), and how it subsequently affects the local control. Material and Methods 444 NPC patients treated with IMRT from 2005 to 2010 were included in the study. The planning aim was to deliver at least 66.5 Gy (i.e. 95% of 70 Gy) to 95% of the primary gross tumor volume (GTV_P) while keeping all the critical neurological organs at risk (OAR) within dose tolerance. Treatment outcome were analyzed according to T stage, GTV_P volume and the degree of under-dosing. Results Disease outcome was related to T stage, GTV_P volume and the degree of under-dosing. The 5-year local failure free survival (LFFS), disease free survival (DFS) and overall survival (OS) for T4 disease were 74%, 50.4% and 63.6% respectively. 48 cm3 was identified as the critical cut-off GTV_P volume, the large volume group (GTV_P ⩾ 48 cm3 ) had lower 5-year DFS (50.4% vs. 76.6%) and OS (65.2% vs. 86.3%, p < 0.001). Most T4 diseases (and some T3) were under-dosed ( |
| doi_str_mv | 10.1016/j.oraloncology.2014.01.017 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1516399149</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1368837514000335</els_id><sourcerecordid>1516399149</sourcerecordid><originalsourceid>FETCH-LOGICAL-c465t-fb4c9f674b1419c9324dbee1dbf9147cb8705d18c53fd352612cea32065311573</originalsourceid><addsrcrecordid>eNqNkl-L1DAUxYu4uOvqV5AiCL50Njdp2sYHQdZ_CyuCjq-G9PZ2J2ObzCatMt9-U2bUxSfhQvLwyzk3h5Nlz4GtgEF1sV35YAbv0A_-Zr_iDMoVgzT1g-wMmloVTCrxMN1F1RSNqOVp9jjGLWNMgmSPslNeSq7qip9l39cbyu24Mzjlvs87H-1IU7CYW2c6up0N7nPv8imQmUZyiZon9CMttDPR7zYm7N0NmSFHE9A6P5r8l502-dWnL-sn2UlvhkhPj-d59u39u_Xlx-L684eryzfXBZaVnIq-LVH1VV22UIJCJXjZtUTQtb2Cssa2qZnsoEEp-k5IXgFHMoKzSgoAWYvz7OVBdxf87Uxx0qONSMNgHPk5apBQCZW0VEJfHVAMPsZAvd4FO6ZPaGB6yVdv9f189ZKvZpBm8Xl29Jnbkbo_T38HmoAXR8BENEMfjEMb_3KNULyRLHFvDxylVH5aCjqiJYfU2UA46c7b_9vn9T8yOFhnk_MP2lPc-jm4lLsGHblm-uvSiKUQUKYyCCHFHc05tYQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1516399149</pqid></control><display><type>article</type><title>The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Ng, Wai Tong ; Lee, Michael C.H ; Chang, Amy T.Y ; Chan, Oscar S.H ; Chan, Lucy L.K ; Cheung, Foon Yiu ; Hung, Wai Man ; Chan, Connie C.C ; Lee, Anne W.M</creator><creatorcontrib>Ng, Wai Tong ; Lee, Michael C.H ; Chang, Amy T.Y ; Chan, Oscar S.H ; Chan, Lucy L.K ; Cheung, Foon Yiu ; Hung, Wai Man ; Chan, Connie C.C ; Lee, Anne W.M</creatorcontrib><description>Summary Background and Purpose This study aims to address the relationship between tumor size and dosimetric inadequacy in treating nasopharyngeal carcinoma (NPC), and how it subsequently affects the local control. Material and Methods 444 NPC patients treated with IMRT from 2005 to 2010 were included in the study. The planning aim was to deliver at least 66.5 Gy (i.e. 95% of 70 Gy) to 95% of the primary gross tumor volume (GTV_P) while keeping all the critical neurological organs at risk (OAR) within dose tolerance. Treatment outcome were analyzed according to T stage, GTV_P volume and the degree of under-dosing. Results Disease outcome was related to T stage, GTV_P volume and the degree of under-dosing. The 5-year local failure free survival (LFFS), disease free survival (DFS) and overall survival (OS) for T4 disease were 74%, 50.4% and 63.6% respectively. 48 cm3 was identified as the critical cut-off GTV_P volume, the large volume group (GTV_P ⩾ 48 cm3 ) had lower 5-year DFS (50.4% vs. 76.6%) and OS (65.2% vs. 86.3%, p < 0.001). Most T4 diseases (and some T3) were under-dosed (<66.5 Gy) and an under-dosed GTV_P volume of 3.4 cm3 was found to be prognostically important. Multivariate analyses showed that the effect of GTV_P volume on LFFR and DFS was outweighed by the degree of under-dosing. Conclusions Treatment outcome of locally advanced NPC was significantly affected by the volume of under-dosed (<66.5 Gy) GTV_P due to the neighboring neurological structures. A new set of OAR dose constraint and specification is proposed.</description><identifier>ISSN: 1368-8375</identifier><identifier>EISSN: 1879-0593</identifier><identifier>DOI: 10.1016/j.oraloncology.2014.01.017</identifier><identifier>PMID: 24529762</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Applied radiobiology (equipment, dosimetry...) ; Biological and medical sciences ; Biological effects of radiation ; Combined Modality Therapy ; Dose specification ; Dosimetry ; Female ; Fundamental and applied biological sciences. Psychology ; Hematology, Oncology and Palliative Medicine ; Humans ; IMRT ; Male ; Medical sciences ; Middle Aged ; Multiple tumors. Solid tumors. Tumors in childhood (general aspects) ; Nasopharyngeal carcinoma ; Nasopharyngeal Neoplasms - drug therapy ; Nasopharyngeal Neoplasms - radiotherapy ; Organ at risk ; Otolaryngology ; Otorhinolaryngology. Stomatology ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; Tissues, organs and organisms biophysics ; Treatment Outcome ; Tumors ; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology ; Young Adult</subject><ispartof>Oral oncology, 2014-05, Vol.50 (5), p.506-512</ispartof><rights>Elsevier Ltd</rights><rights>2014 Elsevier Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c465t-fb4c9f674b1419c9324dbee1dbf9147cb8705d18c53fd352612cea32065311573</citedby><cites>FETCH-LOGICAL-c465t-fb4c9f674b1419c9324dbee1dbf9147cb8705d18c53fd352612cea32065311573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.oraloncology.2014.01.017$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28392850$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24529762$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ng, Wai Tong</creatorcontrib><creatorcontrib>Lee, Michael C.H</creatorcontrib><creatorcontrib>Chang, Amy T.Y</creatorcontrib><creatorcontrib>Chan, Oscar S.H</creatorcontrib><creatorcontrib>Chan, Lucy L.K</creatorcontrib><creatorcontrib>Cheung, Foon Yiu</creatorcontrib><creatorcontrib>Hung, Wai Man</creatorcontrib><creatorcontrib>Chan, Connie C.C</creatorcontrib><creatorcontrib>Lee, Anne W.M</creatorcontrib><title>The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT</title><title>Oral oncology</title><addtitle>Oral Oncol</addtitle><description>Summary Background and Purpose This study aims to address the relationship between tumor size and dosimetric inadequacy in treating nasopharyngeal carcinoma (NPC), and how it subsequently affects the local control. Material and Methods 444 NPC patients treated with IMRT from 2005 to 2010 were included in the study. The planning aim was to deliver at least 66.5 Gy (i.e. 95% of 70 Gy) to 95% of the primary gross tumor volume (GTV_P) while keeping all the critical neurological organs at risk (OAR) within dose tolerance. Treatment outcome were analyzed according to T stage, GTV_P volume and the degree of under-dosing. Results Disease outcome was related to T stage, GTV_P volume and the degree of under-dosing. The 5-year local failure free survival (LFFS), disease free survival (DFS) and overall survival (OS) for T4 disease were 74%, 50.4% and 63.6% respectively. 48 cm3 was identified as the critical cut-off GTV_P volume, the large volume group (GTV_P ⩾ 48 cm3 ) had lower 5-year DFS (50.4% vs. 76.6%) and OS (65.2% vs. 86.3%, p < 0.001). Most T4 diseases (and some T3) were under-dosed (<66.5 Gy) and an under-dosed GTV_P volume of 3.4 cm3 was found to be prognostically important. Multivariate analyses showed that the effect of GTV_P volume on LFFR and DFS was outweighed by the degree of under-dosing. Conclusions Treatment outcome of locally advanced NPC was significantly affected by the volume of under-dosed (<66.5 Gy) GTV_P due to the neighboring neurological structures. A new set of OAR dose constraint and specification is proposed.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Applied radiobiology (equipment, dosimetry...)</subject><subject>Biological and medical sciences</subject><subject>Biological effects of radiation</subject><subject>Combined Modality Therapy</subject><subject>Dose specification</subject><subject>Dosimetry</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>IMRT</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple tumors. Solid tumors. Tumors in childhood (general aspects)</subject><subject>Nasopharyngeal carcinoma</subject><subject>Nasopharyngeal Neoplasms - drug therapy</subject><subject>Nasopharyngeal Neoplasms - radiotherapy</subject><subject>Organ at risk</subject><subject>Otolaryngology</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy, Intensity-Modulated</subject><subject>Tissues, organs and organisms biophysics</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</subject><subject>Young Adult</subject><issn>1368-8375</issn><issn>1879-0593</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkl-L1DAUxYu4uOvqV5AiCL50Njdp2sYHQdZ_CyuCjq-G9PZ2J2ObzCatMt9-U2bUxSfhQvLwyzk3h5Nlz4GtgEF1sV35YAbv0A_-Zr_iDMoVgzT1g-wMmloVTCrxMN1F1RSNqOVp9jjGLWNMgmSPslNeSq7qip9l39cbyu24Mzjlvs87H-1IU7CYW2c6up0N7nPv8imQmUZyiZon9CMttDPR7zYm7N0NmSFHE9A6P5r8l502-dWnL-sn2UlvhkhPj-d59u39u_Xlx-L684eryzfXBZaVnIq-LVH1VV22UIJCJXjZtUTQtb2Cssa2qZnsoEEp-k5IXgFHMoKzSgoAWYvz7OVBdxf87Uxx0qONSMNgHPk5apBQCZW0VEJfHVAMPsZAvd4FO6ZPaGB6yVdv9f189ZKvZpBm8Xl29Jnbkbo_T38HmoAXR8BENEMfjEMb_3KNULyRLHFvDxylVH5aCjqiJYfU2UA46c7b_9vn9T8yOFhnk_MP2lPc-jm4lLsGHblm-uvSiKUQUKYyCCHFHc05tYQ</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Ng, Wai Tong</creator><creator>Lee, Michael C.H</creator><creator>Chang, Amy T.Y</creator><creator>Chan, Oscar S.H</creator><creator>Chan, Lucy L.K</creator><creator>Cheung, Foon Yiu</creator><creator>Hung, Wai Man</creator><creator>Chan, Connie C.C</creator><creator>Lee, Anne W.M</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140501</creationdate><title>The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT</title><author>Ng, Wai Tong ; Lee, Michael C.H ; Chang, Amy T.Y ; Chan, Oscar S.H ; Chan, Lucy L.K ; Cheung, Foon Yiu ; Hung, Wai Man ; Chan, Connie C.C ; Lee, Anne W.M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c465t-fb4c9f674b1419c9324dbee1dbf9147cb8705d18c53fd352612cea32065311573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Applied radiobiology (equipment, dosimetry...)</topic><topic>Biological and medical sciences</topic><topic>Biological effects of radiation</topic><topic>Combined Modality Therapy</topic><topic>Dose specification</topic><topic>Dosimetry</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>IMRT</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple tumors. Solid tumors. Tumors in childhood (general aspects)</topic><topic>Nasopharyngeal carcinoma</topic><topic>Nasopharyngeal Neoplasms - drug therapy</topic><topic>Nasopharyngeal Neoplasms - radiotherapy</topic><topic>Organ at risk</topic><topic>Otolaryngology</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy, Intensity-Modulated</topic><topic>Tissues, organs and organisms biophysics</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ng, Wai Tong</creatorcontrib><creatorcontrib>Lee, Michael C.H</creatorcontrib><creatorcontrib>Chang, Amy T.Y</creatorcontrib><creatorcontrib>Chan, Oscar S.H</creatorcontrib><creatorcontrib>Chan, Lucy L.K</creatorcontrib><creatorcontrib>Cheung, Foon Yiu</creatorcontrib><creatorcontrib>Hung, Wai Man</creatorcontrib><creatorcontrib>Chan, Connie C.C</creatorcontrib><creatorcontrib>Lee, Anne W.M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Oral oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ng, Wai Tong</au><au>Lee, Michael C.H</au><au>Chang, Amy T.Y</au><au>Chan, Oscar S.H</au><au>Chan, Lucy L.K</au><au>Cheung, Foon Yiu</au><au>Hung, Wai Man</au><au>Chan, Connie C.C</au><au>Lee, Anne W.M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT</atitle><jtitle>Oral oncology</jtitle><addtitle>Oral Oncol</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>50</volume><issue>5</issue><spage>506</spage><epage>512</epage><pages>506-512</pages><issn>1368-8375</issn><eissn>1879-0593</eissn><abstract>Summary Background and Purpose This study aims to address the relationship between tumor size and dosimetric inadequacy in treating nasopharyngeal carcinoma (NPC), and how it subsequently affects the local control. Material and Methods 444 NPC patients treated with IMRT from 2005 to 2010 were included in the study. The planning aim was to deliver at least 66.5 Gy (i.e. 95% of 70 Gy) to 95% of the primary gross tumor volume (GTV_P) while keeping all the critical neurological organs at risk (OAR) within dose tolerance. Treatment outcome were analyzed according to T stage, GTV_P volume and the degree of under-dosing. Results Disease outcome was related to T stage, GTV_P volume and the degree of under-dosing. The 5-year local failure free survival (LFFS), disease free survival (DFS) and overall survival (OS) for T4 disease were 74%, 50.4% and 63.6% respectively. 48 cm3 was identified as the critical cut-off GTV_P volume, the large volume group (GTV_P ⩾ 48 cm3 ) had lower 5-year DFS (50.4% vs. 76.6%) and OS (65.2% vs. 86.3%, p < 0.001). Most T4 diseases (and some T3) were under-dosed (<66.5 Gy) and an under-dosed GTV_P volume of 3.4 cm3 was found to be prognostically important. Multivariate analyses showed that the effect of GTV_P volume on LFFR and DFS was outweighed by the degree of under-dosing. Conclusions Treatment outcome of locally advanced NPC was significantly affected by the volume of under-dosed (<66.5 Gy) GTV_P due to the neighboring neurological structures. A new set of OAR dose constraint and specification is proposed.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>24529762</pmid><doi>10.1016/j.oraloncology.2014.01.017</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Applied radiobiology (equipment, dosimetry...) Biological and medical sciences Biological effects of radiation Combined Modality Therapy Dose specification Dosimetry Female Fundamental and applied biological sciences. Psychology Hematology, Oncology and Palliative Medicine Humans IMRT Male Medical sciences Middle Aged Multiple tumors. Solid tumors. Tumors in childhood (general aspects) Nasopharyngeal carcinoma Nasopharyngeal Neoplasms - drug therapy Nasopharyngeal Neoplasms - radiotherapy Organ at risk Otolaryngology Otorhinolaryngology. Stomatology Radiotherapy Dosage Radiotherapy, Intensity-Modulated Tissues, organs and organisms biophysics Treatment Outcome Tumors Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology Young Adult |
| title | The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT |
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