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An elective radiation dose of 46 Gy is feasible in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy: A long-term follow-up result.

Abstract The purpose of this study is to compare the treatment outcome of different radiation doses of elective neck irradiation (ENI) in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).In total, 504 patients with nondisseminated NPC who underwent magnetic resonance imaging before radical IMRT between 2000 and 2008 were retrospectively reviewed. The patients were classified into 2 groups based on the ENI dose: low ENI when the ENI dose was 46 Gy (n = 446) and high ENI when the ENI doses were 50 to 60 Gy (n = 58). All the patients in both the groups received a median dose of 72 Gy to the gross tumor and involved nodes. The fraction size was 2 Gy per fraction. Matching was performed between low ENI and high ENI in a 2:1 ratio, and the matching criteria were N-stage, T-stage, treatment modality, pathology classification, sex, and age.The median follow-up for all patients was 63.5 months. In all patients, the 5-year progression-free survival (PFS), local control (LC), regional control (RC), distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) for low ENI and high ENI patients were 69.0% and 63.2% (P = 0.331), 89.0% and 83.9% (P = 0.235), 90.1% and 85.2% (P = 0.246), 86.8% and 76.6% (P = 0.056), 77.5% and 80.8% (P = 0.926), and 84.4% and 82.5% (P = 0.237), respectively. In the matched-pair analysis, the 5-year PFS, LC, RC, DMFS, OS, and CSS for matched low ENI and high ENI patients were 74.1% and 63.2% (P = 0.134), 92.0% and 83.9% (P = 0.152), 90.1% and 85.2% (P = 0.356), 86.2% and 76.6% (P = 0.125), 87.0% and 80.8% (P = 0.102), and 88.6% and 82.5% (P = 0.080), respectively. In the multivariable analysis for all patients, the ENI group was not a significant factor for PFS, LC, RC, DMFS, OS, and CSS.A low ENI dose of 46 Gy in 23 fractions is feasible in NPC patients treated with IMRT, and this concept should be validated in the prospective studies.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28178144
OWN - NLM
STAT- MEDLINE
DA  - 20170208
DCOM- 20170227
LR  - 20170227
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 6
DP  - 2017 Feb
TI  - An elective radiation dose of 46 Gy is feasible in nasopharyngeal carcinoma
      treated by intensity-modulated radiotherapy: A long-term follow-up result.
PG  - e6036
LID - 10.1097/MD.0000000000006036 [doi]
AB  - The purpose of this study is to compare the treatment outcome of different
      radiation doses of elective neck irradiation (ENI) in nasopharyngeal carcinoma
      (NPC) patients treated with intensity-modulated radiotherapy (IMRT).In total, 504
      patients with nondisseminated NPC who underwent magnetic resonance imaging before
      radical IMRT between 2000 and 2008 were retrospectively reviewed. The patients
      were classified into 2 groups based on the ENI dose: low ENI when the ENI dose
      was 46 Gy (n = 446) and high ENI when the ENI doses were 50 to 60 Gy (n = 58).
      All the patients in both the groups received a median dose of 72 Gy to the gross 
      tumor and involved nodes. The fraction size was 2 Gy per fraction. Matching was
      performed between low ENI and high ENI in a 2:1 ratio, and the matching criteria 
      were N-stage, T-stage, treatment modality, pathology classification, sex, and
      age.The median follow-up for all patients was 63.5 months. In all patients, the
      5-year progression-free survival (PFS), local control (LC), regional control
      (RC), distant metastasis-free survival (DMFS), overall survival (OS), and
      cancer-specific survival (CSS) for low ENI and high ENI patients were 69.0% and
      63.2% (P = 0.331), 89.0% and 83.9% (P = 0.235), 90.1% and 85.2% (P = 0.246),
      86.8% and 76.6% (P = 0.056), 77.5% and 80.8% (P = 0.926), and 84.4% and 82.5% (P 
      = 0.237), respectively. In the matched-pair analysis, the 5-year PFS, LC, RC,
      DMFS, OS, and CSS for matched low ENI and high ENI patients were 74.1% and 63.2% 
      (P = 0.134), 92.0% and 83.9% (P = 0.152), 90.1% and 85.2% (P = 0.356), 86.2% and 
      76.6% (P = 0.125), 87.0% and 80.8% (P = 0.102), and 88.6% and 82.5% (P = 0.080), 
      respectively. In the multivariable analysis for all patients, the ENI group was
      not a significant factor for PFS, LC, RC, DMFS, OS, and CSS.A low ENI dose of 46 
      Gy in 23 fractions is feasible in NPC patients treated with IMRT, and this
      concept should be validated in the prospective studies.
FAU - Hung, Tsung-Min
AU  - Hung TM
AD  - aDepartment of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung
      University, Taoyuan bDepartment of Radiation Oncology, Chang Gung Memorial
      Hospital, Keelung cDepartment of Otorhinolaryngology, Head and Neck Surgery,
      dDepartment of Diagnostic Radiology eDivision of Hematology/Oncology, Department 
      of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University,
      Taoyuan, Taiwan.
FAU - Fan, Kang-Hsing
AU  - Fan KH
FAU - Chen, Eric Yen-Chao
AU  - Chen EY
FAU - Lin, Chien-Yu
AU  - Lin CY
FAU - Kang, Chung-Jan
AU  - Kang CJ
FAU - Huang, Shiang-Fu
AU  - Huang SF
FAU - Liao, Chun-Ta
AU  - Liao CT
FAU - Ng, Shu-Hang
AU  - Ng SH
FAU - Wang, Hung-Ming
AU  - Wang HM
FAU - Chang, Joseph Tung-Chieh
AU  - Chang JT
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - Nasopharyngeal carcinoma
SB  - AIM
SB  - IM
MH  - Disease-Free Survival
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nasopharyngeal Neoplasms/mortality/pathology/*radiotherapy
MH  - Neoplasm Metastasis
MH  - Neoplasm Staging
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Intensity-Modulated/*methods
MH  - Retrospective Studies
PMC - PMC5313001
EDAT- 2017/02/09 06:00
MHDA- 2017/02/28 06:00
CRDT- 2017/02/09 06:00
AID - 10.1097/MD.0000000000006036 [doi]
AID - 00005792-201702100-00025 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Feb;96(6):e6036. doi: 10.1097/MD.0000000000006036.

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