Radiation Oncology Journal

  • 제34권1호
  • /
  • Pages.10-17
  • /
  • 2016
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지
DOI QR코드

DOI QR Code

Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma

  • Seol, Ki Ho (Department of Radiation Oncology, Kyungpook National University School of Medicine) ;
  • Lee, Jeong Eun (Department of Radiation Oncology, Kyungpook National University School of Medicine)
  • 투고 : 2016.01.13
  • 심사 : 2016.03.15
  • 발행 : 2016.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: To evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC). Materials and Methods: Fifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4-72 Gy (39.6-45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed. Results: The median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively. Conclusion: No patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.

키워드

참고문헌

  1. Korea Central Cancer Registry, National Cancer Center. Annual report of cancer statistics in Korea in 2012. Goyang: Ministry of Health and Welfare; 2014.
  2. Sham JS, Choy D, Wei WI. Nasopharyngeal carcinoma: orderly neck node spread. Int J Radiat Oncol Biol Phys 1990;19:929-33. https://doi.org/10.1016/0360-3016(90)90014-B
  3. Tang L, Mao Y, Liu L, et al. The volume to be irradiated during selective neck irradiation in nasopharyngeal carcinoma: analysis of the spread patterns in lymph nodes by magnetic resonance imaging. Cancer 2009;115:680-8. https://doi.org/10.1002/cncr.24049
  4. Ho FC, Tham IW, Earnest A, Lee KM, Lu JJ. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: a metaanalysis of clinical evidence. BMC Cancer 2012;12:98. https://doi.org/10.1186/1471-2407-12-98
  5. Lee AW, Ng WT, Hung WM, et al. Major late toxicities after conformal radiotherapy for nasopharyngeal carcinomapatient-and treatment-related risk factors. Int J Radiat Oncol Biol Phys 2009;73:1121-8. https://doi.org/10.1016/j.ijrobp.2008.05.023
  6. Sung SY, Kang MK, Kay CS, et al. Patterns of care for patients with nasopharyngeal carcinoma (KROG 11-06) in South Korea. Radiat Oncol J 2015;33:188-97. https://doi.org/10.3857/roj.2015.33.3.188
  7. van den Brekel MW, Stel HV, Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 1990;177:379-84. https://doi.org/10.1148/radiology.177.2.2217772
  8. Dawson LA, Anzai Y, Marsh L, et al. Patterns of localregional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2000;46:1117-26. https://doi.org/10.1016/S0360-3016(99)00550-7
  9. Lee AW, Sham JS, Poon YF, Ho JH. Treatment of stage I nasopharyngeal carcinoma: analysis of the patterns of relapse and the results of withholding elective neck irradiation. Int J Radiat Oncol Biol Phys 1989;17:1183-90. https://doi.org/10.1016/0360-3016(89)90524-5
  10. Lee N, Harris J, Garden AS, 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. https://doi.org/10.1200/JCO.2008.19.9109
  11. Lee NY, Zhang Q, Pfister DG, et al. Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multiinstitutional trial. Lancet Oncol 2012;13:172-80. https://doi.org/10.1016/S1470-2045(11)70303-5
  12. Sham JS, Cheung YK, Choy D, Chan FL, Leong L. Computed tomography evaluation of neck node metastases from nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1993; 26:787-92. https://doi.org/10.1016/0360-3016(93)90493-F
  13. Abdel Khalek Abdel Razek A, King A. MRI and CT of nasopharyngeal carcinoma. AJR Am J Roentgenol 2012;198:11-8. https://doi.org/10.2214/AJR.11.6954
  14. King AD, Ma BB, Yau YY, et al. The impact of 18F-FDG PET/CT on assessment of nasopharyngeal carcinoma at diagnosis. Br J Radiol 2008;81:291-8. https://doi.org/10.1259/bjr/73751469
  15. King AD, Ahuja AT, Leung SF, et al. Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease. Head Neck 2000;22:275-81. https://doi.org/10.1002/(SICI)1097-0347(200005)22:3<275::AID-HED10>3.0.CO;2-N
  16. Wang X, Li L, Hu C, et al. Patterns of level II node metastasis in nasopharyngeal carcinoma. Radiother Oncol 2008;89:28-32. https://doi.org/10.1016/j.radonc.2008.07.014
  17. Gao Y, Zhu G, Lu J, et al. Is elective irradiation to the lower neck necessary for N0 nasopharyngeal carcinoma? Int J Radiat Oncol Biol Phys 2010;77:1397-402. https://doi.org/10.1016/j.ijrobp.2009.06.062
  18. Zeng L, Sun XM, Chen CY, et al. Comparative study on prophylactic irradiation to the whole neck and to the upper neck for patients with neck lymph node-negative nasopharyngeal carcinoma. Head Neck 2014;36:687-93. https://doi.org/10.1002/hed.23359
  19. Li JG, Yuan X, Zhang LL, et al. A randomized clinical trial comparing prophylactic upper versus whole-neck irradiation in the treatment of patients with node-negative nasopharyngeal carcinoma. Cancer 2013;119:3170-6. https://doi.org/10.1002/cncr.28201
  20. Chen JZ, Le QT, Han F, et al. Results of a phase 2 study examining the effects of omitting elective neck irradiation to nodal levels IV and Vb in patients with N(0-1) nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2013;85:929-34. https://doi.org/10.1016/j.ijrobp.2012.07.2356
  21. Pow EH, Kwong DL, Sham JS, Lee VH, Ng SC. Can intensitymodulated radiotherapy preserve oral health-related quality of life of nasopharyngeal carcinoma patients? Int J Radiat Oncol Biol Phys 2012;83:e213-21. https://doi.org/10.1016/j.ijrobp.2011.12.040
  22. National Comprehensive Cancer Network. Head and neck cancers version v.1.2015 [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; c2015 [cited 2016 Mar 17]. Available from: http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf.
  23. Fletcher GH, Million RR. Malignant tumors of the nasopharynx. Am J Roentgenol Radium Ther Nucl Med 1965;93:44-55.
  24. Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 1998;16:1310-7. https://doi.org/10.1200/JCO.1998.16.4.1310
  25. Wee J, Tan EH, Tai BC, et al. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol 2005;23:6730-8. https://doi.org/10.1200/JCO.2005.16.790

피인용 문헌

  1. Practice patterns for the radical treatment of nasopharyngeal cancer by head and neck oncologists in the United Kingdom vol.91, pp.1085, 2016, https://doi.org/10.1259/bjr.20170590