Failure patterns and individualized treatment plans of reirradiation for inoperable locally recurrent nasopharyngeal carcinoma.
Humans
Male
Middle Aged
Female
Nasopharyngeal Carcinoma
/ radiotherapy
Neoplasm Recurrence, Local
/ radiotherapy
Re-Irradiation
/ methods
Nasopharyngeal Neoplasms
/ radiotherapy
Adult
Radiotherapy, Intensity-Modulated
/ methods
Aged
Retrospective Studies
Treatment Failure
Precision Medicine
/ methods
Radiotherapy Planning, Computer-Assisted
/ methods
Prognosis
Young Adult
Clinical target volume
Intensity modulated radiation therapy
Recurrent nasopharyngeal carcinoma
Reirradiation
Toxicities
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
02 Aug 2024
02 Aug 2024
Historique:
received:
27
03
2024
accepted:
26
07
2024
medline:
3
8
2024
pubmed:
3
8
2024
entrez:
2
8
2024
Statut:
epublish
Résumé
Re-irradiation with intensity-modulated radiotherapy (IMRT) remains the primary treatment modality for inoperable locally recurrent nasopharyngeal carcinoma (NPC). However, the rate of radiation-related late adverse effects is often substantially high. Therefore, we aimed to explore failure patterns and individualized treatment plans of re-irradiation for inoperable locally recurrent NPC. Ninety-seven patients who underwent IMRT were retrospectively analyzed. Sixty-two patients had clinical target volume of recurrence (rCTV) delineated, and thirty-five patients had only gross tumor volume of recurrence (rGTV) delineated. Twenty-nine patients developed second local failures after re-irradiation with IMRT (28 cases available). Among those patients, 64.3% (18/28) of patients and 35.7% (10/28) developed in-field or out-field, respectively. No statistical correlation was observed between target volume (rGTV or rCTV) and the local recurrence rate, local failure patterns, grade ≥ 3 toxicity, and survival. Multivariate analysis showed that recurrent T (rT) stage (HR 2.62, P = 0.019) and rGTV volume (HR 1.73, P = 0.037) were independent prognostic factors for overall survival (OS). Risk stratification based on rT stage and rGTV volume revealed that low risk group had a longer 3-year OS rate (66.7% vs. 23.4%), lower total grade ≥ 3 toxicity (P = 0.004), and lower re-radiation associated mortality rates (HR 0.45, P = 0.03) than high risk group. This study demonstrates that the delineation of rCTV may not be beneficial for re-irradiation using IMRT in locally recurrent NPC. Patients with low risk were most suitable for re-irradiation, with maximizing local salvage and minimizing radiation-related toxicities. More precise and individualized plans of re-irradiation are warranted.
Identifiants
pubmed: 39095403
doi: 10.1038/s41598-024-68676-1
pii: 10.1038/s41598-024-68676-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
17887Informations de copyright
© 2024. The Author(s).
Références
Chen, Y.-P. et al. Nasopharyngeal carcinoma. Lancet 394(10192), 64–80 (2019).
doi: 10.1016/S0140-6736(19)30956-0
pubmed: 31178151
Lin, S. et al. Update report of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy and hypothesis of the optimal margin. Radiother. Oncol. 110(3), 385–389 (2014).
doi: 10.1016/j.radonc.2014.01.011
pubmed: 24560755
Wong, K. C. W. et al. Nasopharyngeal carcinoma: An evolving paradigm. Nat. Rev. Clin. Oncol. 18(11), 679–695 (2021).
doi: 10.1038/s41571-021-00524-x
pubmed: 34194007
Saraswathula, A. & London, N. R. Jr. Recurrent nasopharyngeal carcinoma and the role of surgery. J. Neurol. Surg. Rep. 84(3), e68–e70 (2023).
doi: 10.1055/s-0043-1770966
pubmed: 37457039
pmcid: 10344595
Chua, M. L. K., Ng, W. T. & Lee, A. W. M. Re-irradiation versus surgery for locally recurrent nasopharyngeal carcinoma. Lancet Oncol. 22(6), e217 (2021).
doi: 10.1016/S1470-2045(21)00143-1
pubmed: 34087127
Yan, W. et al. Induction chemotherapy plus re-irradiation versus re-irradiation alone in locally recurrent nasopharyngeal carcinoma: A model-based analysis. Radiother. Oncol. 188, 109903 (2023).
doi: 10.1016/j.radonc.2023.109903
pubmed: 37678621
You, R. et al. Hyperfractionation compared with standard fractionation in intensity-modulated radiotherapy for patients with locally advanced recurrent nasopharyngeal carcinoma: A multicentre, randomised, open-label, phase 3 trial. Lancet (London, England) 401(10380), 917–927 (2023).
doi: 10.1016/S0140-6736(23)00269-6
pubmed: 36842439
Zong, J. F. et al. Comparison of radiotherapy combined with nimotuzumab versus chemoradiotherapy for locally recurrent nasopharyngeal carcinoma. BMC Cancer 21(1), 1274 (2021).
doi: 10.1186/s12885-021-08995-y
pubmed: 34823489
pmcid: 8620547
Ng, W. T. et al. International recommendations on reirradiation by intensity modulated radiation therapy for locally recurrent nasopharyngeal carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 110(3), 682–695 (2021).
doi: 10.1016/j.ijrobp.2021.01.041
pubmed: 33571626
Yang, X. et al. Analysis of clinical target volume delineation in local-regional failure of nasopharyngeal carcinoma after intensity-modulated radiotherapy. J. Cancer 11(7), 1968–1975 (2020).
doi: 10.7150/jca.39588
pubmed: 32194808
pmcid: 7052868
Kong, F. et al. Patterns of local-regional failure after primary intensity modulated radiotherapy for nasopharyngeal carcinoma. Radiat. Oncol. (London, England) 9, 60 (2014).
doi: 10.1186/1748-717X-9-60
Li, Y. Q. et al. Prognostic model for stratification of radioresistant nasopharynx carcinoma to curative salvage radiotherapy. J. Clin. Oncol. 36(9), 891–899 (2018).
doi: 10.1200/JCO.2017.75.5165
pubmed: 29412781
Tian, Y. M. et al. Impact of primary tumor volume and location on the prognosis of patients with locally recurrent nasopharyngeal carcinoma. Chin. J. Cancer 34(6), 247–253 (2015).
pubmed: 26063113
Yue, Q. et al. Establishment of prognostic factors in recurrent nasopharyngeal carcinoma patients who received salvage intensity-modulated radiotherapy: A meta-analysis. Oral Oncol. 81, 81–88 (2018).
doi: 10.1016/j.oraloncology.2018.04.017
pubmed: 29884418
Lin, S., Chen, X., Li, J. & Hu, C. Expert consensus on the treatment of recurrent nasopharyngeal carcinoma. Chin. J. Radiat. Oncol. 27(01), 16–22 (2018).
Karam, I. et al. Outcomes after reirradiation for recurrent nasopharyngeal carcinoma: North American experience. Head Neck 38(Suppl 1), E1102-1109 (2016).
pubmed: 26451876
Han, F. et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin. Oncol. (Royal College of Radiologists (Great Britain)) 24(8), 569–576 (2012).
doi: 10.1016/j.clon.2011.11.010
Kong, L. et al. Salvage intensity-modulated radiation therapy (IMRT) for locally recurrent nasopharyngeal cancer after definitive IMRT: A novel scenario of the modern era. Sci. Rep. 6, 32883 (2016).
doi: 10.1038/srep32883
pubmed: 27616024
pmcid: 5018695
Chan, O. S. et al. Reirradiation with intensity-modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma. Head Neck 39(3), 533–540 (2017).
doi: 10.1002/hed.24645
pubmed: 27898191
Lee, A. W. M. et al. Management of locally recurrent nasopharyngeal carcinoma. Cancer Treat. Rev. 79, 101890 (2019).
doi: 10.1016/j.ctrv.2019.101890
pubmed: 31470314
Poh, S. S. et al. Retreatment in locally recurrent nasopharyngeal carcinoma: Current status and perspectives. Cancer Commun. (London, England) 41(5), 361–370 (2021).
doi: 10.1002/cac2.12159
Zhan, Y. & Fan, S. Multiple mechanisms involving in radioresistance of nasopharyngeal carcinoma. J. Cancer 11(14), 4193–4204 (2020).
doi: 10.7150/jca.39354
pubmed: 32368302
pmcid: 7196263
Zhang, L., Wang, W., Hu, J., Lu, J. & Kong, L. RBE-weighted dose conversions for patients with recurrent nasopharyngeal carcinoma receiving carbon-ion radiotherapy from the local effect model to the microdosimetric kinetic model. Radiat. Oncol. 15(1), 277 (2020).
doi: 10.1186/s13014-020-01723-z
pubmed: 33302998
pmcid: 7731771
Dionisi, F. et al. Clinical results of proton therapy reirradiation for recurrent nasopharyngeal carcinoma. Acta Oncologica (Stockholm, Sweden) 58(9), 1238–1245 (2019).
doi: 10.1080/0284186X.2019.1622772
pubmed: 31155998
Ng, W. T. et al. Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT-A study by the HKNPCSG. Head Neck 41(10), 3661–3669 (2019).
doi: 10.1002/hed.25892
pubmed: 31350940
Lu, Z. J. et al. Identifying the prognostic value of MRI-based tumor response and predicting the risk of radio-resistance in re-radiotherapy for locally recurrent nasopharyngeal carcinoma. Radiother. Oncol. 183, 109635 (2023).
doi: 10.1016/j.radonc.2023.109635
pubmed: 36963444
Ding, X. et al. Camrelizumab plus apatinib in patients with recurrent or metastatic nasopharyngeal carcinoma: An open-label, single-arm, phase II study. J. Clin. Oncol. 41(14), 2571–2582 (2023).
doi: 10.1200/JCO.22.01450
pubmed: 36735896
pmcid: 10414735
Twu, C. W. et al. Maintenance metronomic chemotherapy for metastatic/recurrent nasopharyngeal carcinoma. Head Neck 44(6), 1453–1461 (2022).
doi: 10.1002/hed.27044
pubmed: 35362634
Zhou, T. et al. Bevacizumab versus placebo in combination with paclitaxel and carboplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma: A multicentre, randomised, open-label, phase II trial. ESMO Open 6(6), 100313 (2021).
doi: 10.1016/j.esmoop.2021.100313
pubmed: 34837744
pmcid: 8637468
Liu, T. et al. Impact of salvage radiotherapy on survival of patients with advanced locally recurrent nasopharyngeal carcinoma: Derivation and validation of a predictive model. Radiother. Oncol. 167, 252–260 (2022).
doi: 10.1016/j.radonc.2021.12.046
pubmed: 34998900