Using the genomic adjusted radiation dose (GARD) to personalize the radiation dose in nasopharyngeal cancer

•GARD is associated with locoregional control in NPC and may serve as a potential framework to personalize radiotherapy dose.•Radiosensitive tumors for which GARD-optimized doses were estimated at less than the current standard (74 Gy) (14.1 %). Locally advanced nasopharyngeal cancer (NPC) patients undergoing radiotherapy are at risk of treatment failure, particularly locoregional recurrence. To optimize the individual radiation dose, we hypothesize that the genomic adjusted radiation dose (GARD) can be used to correlate with locoregional control. A total of 92 patients with American Joint Committee on Cancer / International Union Against Cancer stage III to stage IVB recruited in a randomized phase III trial were assessed (NPC-0501) (NCT00379262). Patients were treated with concurrent chemo-radiotherapy plus (neo) adjuvant chemotherapy. The primary endpoint is locoregional failure free rate (LRFFR). Despite the homogenous physical radiation dose prescribed (Median: 70 Gy, range 66–76 Gy), there was a wide range of GARD values (median: 50.7, range 31.1–67.8) in this cohort. In multivariable analysis, a GARD threshold (GARDT) of 45 was independently associated with LRFFR (p = 0.008). By evaluating the physical dose required to achieve the GARDT (RxRSI), three distinct clinical subgroups were identified: (1) radiosensitive tumors that RxRSI at dose 74 Gy) (N = 13, 14.1 %). GARD is independently associated with locoregional control in radiotherapy-treated NPC patients from a Phase 3 clinical trial. GARD may be a potential framework to personalize radiotherapy dose for NPC patients.