The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT
The impact of dosimetric inadequacy on treatment outcome of nasopharyngeal carcinoma with IMRT
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DOI：
10.1016/j.oraloncology.2014.01.017
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发表时间：
2014-05-01
期刊：
影响因子：
4.8
通讯作者：
Lee, Anne W. M.
中科院分区：
文献类型：
--
作者：
Ng, Wai Tong;Lee, Michael C. H.;Lee, Anne W. M.
背景和目的：本研究旨在探讨鼻咽癌 (NPC) 治疗中肿瘤大小与剂量不足之间的关系，以及它如何影响局部控制。 材料和方法：该研究纳入了 2005 年至 2010 年接受 IMRT 治疗的 444 名鼻咽癌患者。计划目标是向原发肿瘤体积 (GTV_P) 的 95% 提供至少 66.5 Gy（即 70 Gy 的 95%），同时将所有关键的危及神经器官 (OAR) 保持在剂量耐受范围内。根据T分期、GTV_P体积和给药不足程度对治疗结果进行分析。结果：疾病转归与T分期、GTV_P体积和给药不足程度相关。 T4期疾病的5年局部无失败生存率（LFFS）、无病生存率（DFS）和总生存率（OS）分别为74%、50.4%和63.6%。 48 cm(3) 被确定为临界截止 GTV_P 体积，大体积组 (GTV_PP >= 48 cm(3)) 的 5 年 DFS 较低（50.4% vs. 76.6%）和 OS（65.2% vs. 86.3%，p < 0.001）。大多数 T4 疾病（和一些 T3）剂量不足（< 66.5 Gy），3.4 cm(3) 剂量不足的 GTV_P 体积被发现对预后具有重要意义。多变量分析表明，剂量不足的程度超过了 GTV_P 体积对 LFFR 和 DFS 的影响。结论：剂量不足的体积显着影响局部晚期鼻咽癌的治疗结果（
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 cm(3) was identified as the critical cut-off GTV_P volume, the large volume group (GTV_PP >= 48 cm(3)) 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 cm(3) 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 (