Skip to main content
SpringerLink
Log in

Individualized clinical target volume delineation and efficacy analysis in unilateral nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT): 10-year summary

  • Original Article – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the long-term local control, failure patterns, and toxicities after individualized clinical target volume (CTV) delineation in unilateral nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).

Methods

Unilateral NPC was defined as a nasopharyngeal mass confined to one side of the nasopharynx and did not exceed the midline. From November 2003 to December 2017, 95 patients were retrospectively included. All patients received IMRT. The CTVs were determined based on the distance from the gross tumor. The contralateral para-pharyngeal space and skull base orifices were spared from irradiation.

Results

There were three local recurrences and eight regional recurrences in 10 patients during an 84-month follow-up. All local recurrences were within PGTVnx, and all in-field recurrences. No recurrences were found in traditional high-risk areas including contralateral the para-pharyngeal space and skull base orifices. The 10-year local-recurrence-free survival, regional-recurrence-free survival and overall survival were 96.2%, 90.5% and 84.7%, respectively. The dosimetry parameters of the tumor-contralateral organs were all lower than the values of the tumor-ipsilateral side (P < 0.05). The late toxicities occurred mainly in the tumor-ipsilateral organs, including radiation-induced temporal lobe injury, impaired visuality, hearing loss and subcutaneous fibrosis.

Conclusion

Individualized CTV delineation in unilateral NPC could yield excellent long-term local control with limited out-of-field recurrences, reduced dose to tumor- contralateral organs and mild late toxicities, which is worthy of further exploration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and material

The datasets used and/or analyzed during the current study were uploaded onto the Research Data Deposit public platform (www.researchdata.org.cn), with the RDD approval number RDDB2020001032.

Abbreviations

IMRT:

Intensity-modulated radiotherapy

NPC:

Nasopharyngeal carcinoma

LCR:

Local control rate

GTV:

Gross tumor volume

CTV:

Clinical target volume

TLI:

Temporal lobe injury

SYSUCC:

Sun Yat-sen University Cancer Center

ENS:

Electronic nasopharyngoscope

MRI:

Magnetic resonance imaging

PS:

Performance status

AJCC:

American Joint Committee on Cancer

CCRT:

Concurrent chemo-radiotherapy

IC:

Induction chemotherapy

CT:

Computed tomography

OARs:

Organs at risk

ICRU:

The International Commission on Radiation Units and Measurement

CTV1:

High-risk clinical target volume

CTV2:

Low-risk clinical target volume

RTOG:

Radiation Therapy Oncology Group

PTV:

Planning target volume

ECT:

Emission computed tomography

PET/CT:

Positron emission tomography-computed tomography

LRFS:

Local-recurrence-free survival

OS:

Overall survival

RRFS:

Regional relapse-free survival

DMFS:

Distant metastasis-free survival

PFS:

Progression-free survival

Dmean:

Mean dose

Dmin:

Minimum dose

Dmax:

Maximum dose

References

  • Au KH, Ngan Roger KC, Ng Alice WY et al (2018) Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong: A report of 3328 patients (HKNPCSG 1301 study). Oral Oncol 77:16–21

    Article  CAS  Google Scholar 

  • Chen Q-Y, Wen Y-F, Guo L et al (2011) Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst 103:1761–1770

    Article  Google Scholar 

  • Chen L, Zhang Y, Lai S-Z et al (2019) 10-year results of therapeutic ratio by intensity-modulated radiotherapy versus two-dimensional radiotherapy in patients with nasopharyngeal carcinoma. Oncologist 24:e38–e45

    Article  Google Scholar 

  • Clifford CKS, Ozyigit G, Tran BN et al (2003) Patterns of failure in patients receiving definitive and postoperative IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys 55:312–321

    Article  Google Scholar 

  • Dawson LA, Anzai Y, Marsh L et al (2000) Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 46:1117–1126

    Article  CAS  Google Scholar 

  • Grégoire V, Evans M, Le Q-T et al (2018) Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO TROG Consensus Guidelines. Radiother Oncol 126:3–24

    Article  Google Scholar 

  • Lai S-Z, Li W-F, Chen L et al (2011) How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients? Int J Radiat Oncol Biol Phys 80:661–668

    Article  Google Scholar 

  • Lee N, Xia P, Quivey Jeanne M et al (2002) Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 53:12–22

    Article  Google Scholar 

  • Lee Anne W, Ng WT, Pan JJ et al (2018) International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma. Radiother Oncol 126:25–36

    Article  CAS  Google Scholar 

  • Li X-Y, Chen Q-Y, Sun X-S et al (2019) Ten-year outcomes of survival and toxicity for a phase III randomised trial of concurrent chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma. Eur J Cancer 110:24–31

    Article  Google Scholar 

  • Liu Y-P, Wen Y-H, Tang J et al (2021) Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Oncol 22:381–390

    Article  Google Scholar 

  • McDowell Lachlan J, Rock K, Xu W et al (2018) Long-Term late toxicity, quality of life, and emotional distress in patients with nasopharyngeal carcinoma treated with intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 102:340–352

    Article  CAS  Google Scholar 

  • Miao J, Di M, Chen B et al (2020) A prospective 10-year observational study of reduction of radiation therapy clinical target volume and dose in early-stage nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 107:672–682

    Article  Google Scholar 

  • National Comprehensive Cancer Network (2018) (NCCN) Clinical Practice Guidelines in Oncology. Head and Neck Cancer, Version 1. 2018. https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 15 Feb 2018

  • Ng WT, Soong YL, Ahn YC et al (2021) International recommendations on reirradiation by intensity modulated radiation therapy for locally recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 110:682–695

    Article  Google Scholar 

  • Sanford Nina N, Jackson L, Lam Miranda B et al (2019) Individualization of clinical target volume delineation based on stepwise spread of nasopharyngeal carcinoma: outcome of more than a decade of clinical experience. Int J Radiat Oncol Biol Phys 103:654–668

    Article  CAS  Google Scholar 

  • Su S-F, Han F, Zhao C et al (2012) Long-term outcomes of early-stage nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy alone. Int J Radiat Oncol Biol Phys 82:327–333

    Article  Google Scholar 

  • Sun Y, Yu X-L, Luo W et al (2014) Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Radiother Oncol 110:390–397

    Article  Google Scholar 

  • Sun Y, Yu X-L, Zhang G et al (2016) Reduction of clinical target volume in patients with lateralized cancer of the nasopharynx and without contralateral lymph node metastasis receiving intensity-modulated radiotherapy. Head Neck 38(S1):E468–E472

    Article  Google Scholar 

  • Wang L, Wu Z, Xie D et al (2019) Reduction of target volume and the corresponding dose for the tumor regression field after induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma. Cancer Res Treat 51:685–695

    Article  CAS  Google Scholar 

  • Wu L-R, Liu Y-T, Jiang N et al (2017) Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: an analysis of 614 patients from a single center. Oral Oncol 69:26–32

    Article  Google Scholar 

  • Wu Z, Wang L, Xie D-H et al (2021) Failure patterns and prognostic factors for cervical node-negative nasopharyngeal carcinoma in the intensity-modulated radiotherapy era. Asia Pac J Clin Oncol 17:330–337

    Article  Google Scholar 

  • Xie D, Cheng W, Lv S et al (2019) Target delineation and dose prescription of adaptive replanning intensity-modulated radiotherapy for nasopharyngeal carcinoma. Cancer Commun (lond) 39:18

    Article  Google Scholar 

  • Zeng L, Huang S-M, Tian Y-M et al (2015) Normal tissue complication probability model for radiation-induced temporal lobe injury after intensity-modulated radiation therapy for nasopharyngeal carcinoma. Radiology 276:243–249

    Article  Google Scholar 

  • Zhang F, Zhang Y, Li W-F et al (2015) Efficacy of concurren chemotherapy for intermediate risk NPC in the intensity-modulated radiotherapy era: a propensity-matched analysis. Sci Rep 5:17378

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.

Funding

The authors declare that they had no funding for this study.

Author information

Author notes

  1. De-Huan Xie, Zheng Wu and Wang-Zhong Li have contributed equally to this paper.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dong Feng Road East, Guangzhou, 510060, China

    Ya-Lan Tao, Fei-Fei Lin, Jun Ma, Shao-Min Huang, Tai-Xiang Lu & Yong Su

  2. State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Nasopharyngeal Carcinoma, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China

    De-Huan Xie, Wang-Zhong Li & Chong Zhao

  3. Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China

    Zheng Wu & Ya-Qian Han

  4. Department of Radiation Oncology, Shunde Hospital of Southern Medical University, Foshan, 528399, China

    Wan-Qin Cheng

  5. State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of VIP Region, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China

    Lei Wang

  6. Faculty of Health, Medicine and Life Sciences, Maastricht University, Minder Broedersberg 4-6, 6211, LK, Maastricht, The Netherlands

    Shao-Wen Lv

  7. Department of Radiation Oncology, Armed Forces Hospitals Southern Region, Guangzhou, 510060, China

    Nian-Ji Cui

Authors
  1. De-Huan Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zheng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wang-Zhong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wan-Qin Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ya-Lan Tao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shao-Wen Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fei-Fei Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nian-Ji Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jun Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shao-Min Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tai-Xiang Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ya-Qian Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yong Su
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DHX, ZW, WZL, YS, and YQH designed the study. DHX, ZW, YS, TXL, JM, CZ, NJC, WQC, LW, and SWL delineated the targets and performed radiation treatment DHX, ZW, WZL, WQC, YLT, LW, SWL, FFL, and SMH acquired data DHX, ZW, WZL, analyzed and interpreted the data. DHX, ZW, WZL, and YS wrote the manuscript, and revised the manuscript. All authors have reviewed the manuscript and approved the final version.

Corresponding authors

Correspondence to Ya-Qian Han or Yong Su.

Ethics declarations

Conflicts of interest/Competing interests

The authors declare that they have no competing interests.

Ethics approval

Retrospective ethical approval was obtained from the institutional ethics committee of the Sun Yat‑sen University Cancer Center, with the approval number B2019-169–01. Written informed treatment consents were required from all patients with respect to chemotherapy and/or radiotherapy.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xie, DH., Wu, Z., Li, WZ. et al. Individualized clinical target volume delineation and efficacy analysis in unilateral nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT): 10-year summary. J Cancer Res Clin Oncol 148, 1931–1942 (2022). https://doi.org/10.1007/s00432-022-03974-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-022-03974-7

Keywords

Search

Navigation