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Radiation-induced nasopharyngeal ulcers after re-irradiation with intensity-modulated radiotherapy in locoregional recurrent nasopharyngeal carcinoma patients: a dose–volume–outcome analysis

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Abstract

Objective

To analyze the interrelation between radiation dose and radiation-induced nasopharyngeal ulcer (RINU) in locoregional recurrent nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).

Methods

Clinical data were collected from 363 patients with locoregional recurrent NPC who received re-irradiated with definitive IMRT from 2009 to 2017. Twenty-nine patients were diagnosed with RINU. Univariate and multivariate analyses were used to re-evaluate the first and second radiotherapy plans and to identify predictive dosimetric factors.

Results

All dosimetric parameters were notably associated with the progression to RINU (p < 0.01) using paired samples Wilcoxon signed rank tests. Multivariate analysis showed that EQD2_ \(\sum\)D80 (dose for 80 percent volume of the unilateral nasopharynx lesion) was an independent prognostic factor for RINU (p = 0.001). The area under the ROC curve for EQD2_ \(\sum\)D80 was 0.846 (p < 0.001), and the cutoff point of 137.035 Gy could potentially be the dose tolerance of the nasopharyngeal mucosa.

Conclusions

The sum of equivalent dose in 2 Gy fractions (EQD2) in the overlapping volumes between initial and re-irradiated nasopharyngeal mucosal tissue can be effective in predicting the hazard of developing RINU in NPC patients undergoing radical re‑irradiation with IMRT and we propose a EQD2_ \(\sum\)D80 threshold of 137.035 Gy for the nasopharynx.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

RINU:

Radiation-induced nasopharyngeal ulcer

NPC:

Nasopharyngeal carcinoma

EQD2 :

Equivalent dose in 2 Gy fractions

ROC:

Receiver operating characteristics

IMRT:

Intensity-modulated radiotherapy

AJCC:

American joint committee on cancer

PTV:

Planning target volume

CTV:

Clinical target volume

GTV:

Gross tumor volume

RTOG:

Radiation therapy oncology group

DVH:

Dose and volume histogram

UFI:

Ulcer-free interval time

TTR:

Time to relapse

LRRFS:

Locoregional relapse-free survival

OS:

Overall survival

CR:

Complete response

QOL:

Quality of life

CT:

Computed tomography

MRI:

Magnetic resonance imaging

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Acknowledgements

We acknowledge the support of the Department of Radiation Oncology of Fudan University Shanghai Cancer Center.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Meng-Shan Ni and Fang-Fang Kong have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Radiotherapy, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People’s Republic of China

    Meng-Shan Ni

  2. Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People’s Republic of China

    Meng-Shan Ni

  3. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University Shanghai Cancer Center, Room 703, Building 1, Dong’an Road 270, Shanghai, 200032, China

    Meng-Shan Ni, Fang-Fang Kong, Guang-Sen Pan, Cheng-Run Du, Rui-Ping Zhai, Chao-Su Hu & Hong-Mei Ying

  4. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Meng-Shan Ni, Fang-Fang Kong, Guang-Sen Pan, Cheng-Run Du, Rui-Ping Zhai, Chao-Su Hu & Hong-Mei Ying

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Contributions

MSN and FFK conducted data analysis and drafted the manuscript. GSP, RPZ and CRD participated in data collection. CSH and HMY participated in the design of the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hong-Mei Ying.

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Conflict of interest

The authors have declared that no competing interest exists.

Ethics approval

The present study was approved by the Institutional Review Board of Fudan University Shanghai Cancer Center (Approval number 2009224–1).

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Ni, MS., Kong, FF., Pan, GS. et al. Radiation-induced nasopharyngeal ulcers after re-irradiation with intensity-modulated radiotherapy in locoregional recurrent nasopharyngeal carcinoma patients: a dose–volume–outcome analysis. Eur Arch Otorhinolaryngol 281, 1425–1434 (2024). https://doi.org/10.1007/s00405-023-08330-0

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  • DOI: https://doi.org/10.1007/s00405-023-08330-0

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