|Table of Contents|

The role of adaptive radiotherapy in radical radiotherapy for nasopharyngeal carcinoma

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 07
Page:
1285-1290
Research Field:
Publishing date:

Info

Title:
The role of adaptive radiotherapy in radical radiotherapy for nasopharyngeal carcinoma
Author(s):
ZHANG Yongqian1; WANG Hongmin2; AN Yonghui1; LI Na1; BO Changwen1; ZHAO Yingchun1; ZHANG Changwang1; GUO Yan1; MA Wenhua1
1.Department of Oncology;2.Department of Neurology,the First Hospital of Hebei Medical University,Hebei Shijiazhuang 050031,China.
Keywords:
nasopharyngeal carcinoma; radiotherapy; adaptive radiotherapy; prognosis; dosimetry
PACS:
R739.62
DOI:
10.3969/j.issn.1672-4992.2023.07.020
Abstract:
Objective:To evaluate the dosimetry characteristics,clinical efficacy,and safety of adaptive radiotherapy(ART) in intensity-modulated radiotherapy for nasopharyngeal carcinoma(NPC).Methods:37 patients with nasopharyngeal carcinoma who received radical concurrent intensity-modulated radiotherapy and chemotherapy from February 2018 to January 2020 were selected and randomly divided into the ART group and the conventional radiotherapy group.Patients in the ART group received repositioning and replan on the first day of the 5th week of radiotherapy,and the remaining radiotherapy was completed by the new plan.In the conventional radiotherapy group,the initial treatment plan was used until the end of radiotherapy,but on the first day of the 5th week of radiotherapy,a new CT scan was performed and the initial treatment plan was copied into this CT to obtain a new dose distribution(defined as Plan-virtual).The dosimetric indexes of Plan-ART and Plan-virtual were compared,and the side effects,complete response(CR) of tumor and prognosis of patients in the two groups were compared.Results:There was no significant difference between the Plan-ART group and the Plan-virtual group in D2 and mean dose(Dmean) of pGTV,PTV1 and PTV2.In Plan-virtual,D95,D98 and D100 of pGTV were significantly lower than those in Plan-ART,D95,D98 and D100 of PTV1 and PTV2 were significantly lower than those in Plan-ART,and D2 of the spinal cord,mean dose and V30 of the parotid gland were significantly higher,with statistical significance.The CR rates of the ART group and the conventional radiotherapy group at 8 weeks after radiotherapy were 88.9% and 78.9%,respectively(P=0.66).The 2-year local-regional recurrence-free survival rates were 80.7% and 70.8%,respectively(P=0.69).The 2-year distant metastasis-free survival rates were 86.3% and 83.2%,respectively(P=1.00).The 2-year overall survival rates were 87.5% and 82.2%,respectively(P=0.53).The incidence of oral pain,mucositis,esophagitis/dysphagia and dry mouth in the ART group was significantly lower than that in the conventional radiotherapy group.Conclusion:Adaptive radiotherapy at the beginning of the 5th week of radiotherapy for nasopharyngeal carcinoma can further optimize the dose coverage of the target,better protect the organs at risk,and reduce local side effects,so as to benefit patients.

References:

[1] CHEN YP,CHAN ATC,LE QT,et al.Nasopharyngeal carcinoma［J］.Lancet,2019,394(10192):64-80.
[2] KAM MK,CHAU RM,SUEN J,et al.Intensity-modulated radiotherapy in nasopharyngeal carcinoma:dosimetric advantage over conventional plans and feasibility of dose escalation［J］.Int J Radiat Oncol Biol Phys,2003,56(1):145-157.
[3] POON M,HOLBORN C,CHENG KF,et al.Evaluation of deformed image-based dose calculations for adaptive radiotherapy of nasopharyngeal carcinoma［J］.Med Dosim,2017,42(4):273-281.
[4] HUANG H,LU H,FENG G,et al.Determining appropriate timing of adaptive radiation therapy for nasopharyngeal carcinoma during intensity-modulated radiation therapy ［J/OL］.Radiat Oncol,(2015-09-17)［2022-06-21］.https://pubmed.ncbi.nlm.nih.gov/26377685.DOI:10.1186/s13014-015-0498-1.
[5] MORGAN HE,SHER DJ.Adaptive radiotherapy for head and neck cancer ［J/OL］.Cancers Head Neck,(2020-01-09)［2022-06-21］.https://pubmed.ncbi.nlm.nih.gov/31938572.DOI:10.1186/s41199-019-0046-z.
[6] DELANEY G,JACOB S,BARTON M.Estimation of an optimal external beam radiotherapy utilization rate for head and neck carcinoma［J］.Cancer,2005,103(11):2216-2227.
[7] 张勇乾,张富利,王雅棣,等.头颈部肿瘤HT剂量学研究［J］.中华放射肿瘤学杂志,2014,23(6):519-522. ZHANG YQ,ZHANG FL,WANG YD,et al.A dosimetry study for head and neck cancer patients treated with helical TomoTherapy［J］.Chinese Journal of Radiation Oncology,2014,23(6):519-522.
[8] 蒋华勇,张勇乾,王雅棣,等.头颈部肿瘤放疗过程中腮腺变化对照射剂量影响的研究［J］.中华放射医学与防护杂志,2014,34(11):845-849. JIANG HY,ZHANG YQ,WANG YD,et al.Study on the effect of parotid gland change on radiation dose during radiotherapy for head and neck cancer［J］.Chinese Journal of Radiological Medicine and Protection,2014,34(11):845-849.
[9] 曹新格,王雅棣,张勇乾,等.鼻咽癌螺旋断层治疗的剂量学研究［J］.中华放射肿瘤学杂志,2016,25(8):802-806. CAO XG,WANG YD,ZHANG YQ,et al.A dosimetry study for nasopharyngeal carcinoma patients treated with helical TomoTherapy［J］.Chinese Journal of Radiation Oncology,2016,25(8):802-806.
[10] BAK B,SKROBALA A,ADAMSKA A,et al.What information can we gain from performing adaptive radiotherapy of head and neck cancer patients from the past 10 years［J］.Cancer Radiother,2022,26(3):502-516.
[11] LU J,MA Y,CHEN J,et al.Assessment of anatomical and dosimetric changes by a deformable registration method during the course of intensity-modulated radiotherapy for nasopharyngeal carcinoma［J］.J Radiat Res,2014,55(1):97-104.
[12] MNEJJA W,DAOUD H,FOURATI N,et al.Dosimetric impact on changes in target volumes during intensity-modulated radiotherapy for nasopharyngeal carcinoma［J］.Rep Pract Oncol Radiother,2020,25(1):41-45.
[13] HAN C,CHEN YJ,LIU A,et al.Actual dose variation of parotid glands and spinal cord for nasopharyngeal cancer patients during radiotherapy［J］.Int J Radiat Oncol Biol Phys,2008,70(4):1256-1262.
[14] TASAKA S,JINGU K,TAKAHASHI N,et al.The long-term recovery of parotid glands in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy［J/OL］.Front Oncol,(2021-05-07)［2022-06-21］.https://pubmed.ncbi.nlm.nih.gov/34026643.DOI:10.3389/fonc.2021.665837.
[15] ZHENG L,TONG L,DU F,et al.Effect of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy on parotid gland function and quality of life in patients with nasopharyngeal carcinoma［J］.Am J Transl Res,2021,13(5):5272-5279.
[16] FENG M,YIN Q,REN J,et al.Dynamic three-dimensional ADC changes of parotid glands during radiotherapy predict the salivary secretary function in patients with head and neck squamous carcinoma［J/OL］.Front Oncol,(2021-04-13)［2022-06-21］.https://pubmed.ncbi.nlm.nih.gov/33928037.DOI:10.3389/fonc.2021.651537.
[17] ARSLAN SA.Clinical outcomes of nasopharyngeal carcinoma patients treated with adaptive helical tomotherapy,a 5-year experience［J］.Niger J Clin Pract,2020,23(12):1683-1689.
[18] MAHESHWARI G,DHANAWAT A,KUMAR HS,et al.Clinical and dosimetric impact of adaptive intensity-modulated radiotherapy in locally advanced head-and-neck cancer［J］.J Cancer Res Ther,2020,16(3):600-604.
[19] LUO Y,QIN Y,LANG J.Effect of adaptive replanning in patients with locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiotherapy:a propensity score matched analysis［J］.Clin Transl Oncol,2017,19(4):470-476.
[20] SUN Y,LI WF,CHEN NY,et al.Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,multicentre,randomised controlled trial［J］.Lancet Oncol,2016,17(11):1509-1520.
[21] FRIKHA M,AUPERIN A,TAO Y,et al.A randomized trial of induction docetaxel-cisplatin-5 FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma(GORTEC 2006-02)［J］.Ann Oncol,2018,29(3):731-736.
[22] 姚伟荣,杜镭,马林,等.疗程中再计划对鼻咽癌螺旋断层放疗不良反应及临床疗效的影响［J］.中南大学学报(医学版),2013,38(05):468-475. YAO WR,DU L,MA L,et al.Effect of adaptive replanning on adverse reactions and clinical outcome in nasophryngeal carcinoma treated by helical tomotherapy［J］.Journal of Central South University(Medical Science),2013,38(05):468-475.

Memo

Memo:
河北省医学科学研究重点课题计划项目(编号：20180229)
Last Update: 2023-02-28