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IMRT vs. 2D-radiotherapy or 3D-conformal radiotherapy of nasopharyngeal carcinoma

Survival outcome in a Korean multi-institutional retrospective study (KROG 11-06)

IMRT vs. 2D-Strahlentherapie oder konformaler 3D-Strahlentherapie beim Nasopharynxkarzinom

Folgen für das Überleben in einer koreanischen multizentrischen retrospektiven Studie (KROG 11-06)

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Abstract

Objective

We compared treatment outcomes of two-dimensional radiotherapy (2D-RT), three-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).

Patients and methods

In total, 1237 patients with cT1-4N0-3M0 NPC were retrospectively analyzed. Of these, 350, 390, and 497 were treated with 2D-RT, 3D-CRT, and IMRT, respectively.

Results

3D-CRT and IMRT showed better 5-year overall survival (OS) rates (73.6 and 76.7 %, respectively) than did 2D-RT (5-year OS of 59.7 %, all p < 0.001). In T3–4 subgroup, IMRT was associated with a significantly better 5-year OS than was 2D-RT (70.7 vs. 50.4 %, respectively; p ≤ 0.001) and 3D-CRT (70.7 vs. 57.8 %, respectively; p = 0.011); however, the difference between the 2D-RT and 3D-CRT groups did not reach statistical significance (p = 0.063). In multivariate analyses of all patients, IMRT was a predictive factor for OS when compared with 2D-RT or 3D-CRT, as was 3D-CRT when compared with 2D-RT.

Conclusion

Our study showed that 3D-CRT and IMRT were associated with a better local progression-free survival and OS than was 2D-RT in NPC. IMRT was significantly superior in terms of OS for advanced primary tumors (T3–4).

Zusammenfassung

Zielsetzung

Wir verglichen die Behandlungsergebnisse von zweidimensionaler Strahlentherapie (2D-RT), dreidimensionaler konformer Strahlentherapie (3D-CRT) und intensitätsmodulierter Strahlentherapie (IMRT) bei Patienten mit Nasopharynxkarzinom (NPC).

Patienten und Methoden

Insgesamt 1237 Patienten mit NPC im Stadium cT1–4/N0–3/M0 wurden rückwirkend analysiert. Von diesen wurden jeweils 350, 390 und 497 mit 2D-RT, 3D-CRT und IMRT behandelt.

Ergebnisse

3D-CRT und IMRT zeigten eine bessere 5-Jahres-Gesamtüberlebensrate (5y-OS; jeweils 73,6 und 76,7%) als 2D-RT (59,7%; alle p < 0,001). In der Untergruppe T3–4 war die IMRT mit einer erheblich besseren 5y-OS verbunden als 2D-RT (jeweils 70,7 vs. 50,4%; p ≤ 0,001) und 3D-CRT (jeweils 70,7 vs. 57,8%; p = 0,011); jedoch gab es keinen Unterschied zwischen den Gruppen 2D-RT und 3D-CRT(p = 0,063). In multivariater Analyse von allen Patienten war die IMRT ein prädiktiver Faktor für das OS im Vergleich mit 2D-RT oder 3D-CRT, hingegen 3D-CRT verglichen mit 2D-RT.

Schlussfolgerung

Unsere Studie zeigte, dass 3D-CRT und IMRT mit dem lokalen progressionsfreien Überleben und OS besser verbunden sind als 2D-RT in NPC. IMRT war erheblich überlegen in Bezug auf das OS für fortgeschrittene primäre Tumoren (T3–4).

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Acknowledgments

The authors would like to thank Jihye Cha, M.D., Jae Myoung Noh, M.D., Won Taek Kim, M.D., Young Taek Oh, M.D., Min Kyu Kang, M.D., Jin hee Kim, M.D., Ji-Yoon Kim, M.D., and Sung Whan Kim, M.D. for contribution. Supported by NCC Grant No.1310070 from National Cancer Center.

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Authors and Affiliations

  1. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, 10408, Ilsandong-gu, Goyang-si Gyeonggi-do, Republic of Korea

    Sung Ho Moon M.D. &  Kwan Ho Cho M.D.

  2. Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, 03722, Seodaemun-gu, Seoul, Republic of Korea

    Chang-Geol Lee M.D. &  Ki Chang Keum M.D.

  3. Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, 222 Banpo-daero, 06591, Seocho-gu, Seoul, Republic of Korea

    Yeon-Sil Kim M.D.

  4. Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, 03080, Jongno-gu, Seoul, Republic of Korea

    Hong-Gyun Wu M.D. &  Jin Ho Kim M.D.

  5. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, 06351, Gangnam-gu, Seoul, Republic of Korea

    Yong Chan Ahn M.D. &  Dongryul Oh M.D.

  6. Department of Radiation Oncology, The Catholic University of Korea, College of Medicine, 93 Jungbu-daero, 16247, Paldal-gu, Suwon, Gyeonggi-do, Republic of Korea

    Jong Hoon Lee M.D.

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  1. Sung Ho Moon M.D.
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  2. Kwan Ho Cho M.D.
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Correspondence to Kwan Ho Cho M.D..

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Conflict of interest

S.H. Moon, K.H. Cho, C.-G. Lee, K. C. Keum, Y.-S. Kim, H.-G. Wu, J.H. Kim, Y.C. Ahn, D. Oh, and J.H. Lee state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Moon, S.H., Cho, K.H., Lee, CG. et al. IMRT vs. 2D-radiotherapy or 3D-conformal radiotherapy of nasopharyngeal carcinoma. Strahlenther Onkol 192, 377–385 (2016). https://doi.org/10.1007/s00066-016-0959-y

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