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Prognostic value of tumor volume for patients with nasopharyngeal carcinoma treated with concurrent chemotherapy and intensity-modulated radiotherapy

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Abstract

Purpose

We aimed to analyze prognostic factors in patients with nasopharyngeal carcinoma (NPC) treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT); in addition, we aimed to elucidate the value of primary gross tumor volume (GTVp) in predicting prognosis of patients.

Methods

Between February 2001 and December 2008, 321 patients with NPC treated with concurrent chemotherapy and IMRT were analyzed retrospectively. GTVp was calculated from treatment planning computed tomography scans. A receiver operating characteristics (ROC) curve was used to determine the best cutoff point of GTVp.

Results

The 5-year local failure-free survival (LFFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) for NPC patients were 93.8, 80.1, 73.0, and 83.7 %, respectively. Univariate and multivariate analyses indicated that GTVp had exhibited a statistically significant correlation with LFFS, DMFS, DFS, and OS (P < 0.05, all), whereas T classification was not an independent prognostic factor. According to ROC curve analysis, 49 and 19 mL were determined as the cutoff points of GTVp for local control and distant metastasis, respectively. Based on this, 321 patients were divided into three volume subgroups. LFFS, DMFS, DFS, and OS demonstrated significant differences among patients in different volume subgroups (P < 0.001, all) and were superior to T classification for predicting prognosis of NPC patients.

Conclusions

Primary gross tumor volume is an independent prognostic factor in local control, distant metastasis, disease-free survival, and overall survival in NPC. An adjusted TNM staging system that includes GTVp as a quantitative indicator to evaluate prognosis is warranted.

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References

  • Baujat B, Bourhis J, Chan AT et al (2006) Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys 64:47–56

    Article  CAS  PubMed  Google Scholar 

  • Bentzen SM, Thames HD (1996) Tumor volume and local control probability: clinical data and radiobiological interpretations. Int J Radiat Oncol Biol Phys 36:247–251

    Article  CAS  PubMed  Google Scholar 

  • Brenner DJ (1993) Dose, volume, and tumor-control predictions in radiotherapy. Int J Radiat Oncol Biol Phys 26:171–179

    Article  CAS  PubMed  Google Scholar 

  • Chang CC, Chen MK, Liu MT et al (2002) The effect of primary tumor volumes in advanced T-staged nasopharyngeal tumors. Head Neck 24:940–946

    Article  PubMed  Google Scholar 

  • Chen MK, Chen TH, Liu JP et al (2004) Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary tumor volume. Cancer 100:2160–2166

    Article  PubMed  Google Scholar 

  • Chen L, Liu LZ, Mao YP et al (2011) Grading of MRI-detected skull-base invasion in nasopharyngeal carcinoma and its prognostic value. Head Neck 33:1309–1314

    Article  PubMed  Google Scholar 

  • Chua DT, Sham JS, Kwong DL et al (1997) Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome. Int J Radiat Oncol Biol Phys 39:711–719

    Article  CAS  PubMed  Google Scholar 

  • Dubben HH, Thames HD, Beck-Bornholdt HP (1998) Tumor volume: a basic and specific response predictor in radiotherapy. Radiother Oncol 47:167–174

    Article  CAS  PubMed  Google Scholar 

  • Johnson CR, Thames HD, Huang DT et al (1995) The tumor volume and clonogen number relationship: tumor control predictions based upon tumor volume estimates derived from computed tomography. Int J Radiat Oncol Biol Phys 33:281–297

    Article  CAS  PubMed  Google Scholar 

  • Kam MK, Teo PM, Chau RMC et al (2004) Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys 60:1440–1450

    Article  PubMed  Google Scholar 

  • Langendijk JA, Leemans CR, Buter J et al (2004) The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol 22:4604–4612

    Article  CAS  PubMed  Google Scholar 

  • Lee N, Xia P, Quivey JM et al (2002) Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 53:12–22

    Article  PubMed  Google Scholar 

  • Lee AW, Lau WH, Tung SY et al (2005) Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 23:6966–6975

    Article  CAS  PubMed  Google Scholar 

  • Lin JC, Jan JS, Hsu CY et al (2003) Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol 21:631–637

    Article  PubMed  Google Scholar 

  • Lin S, Pan J, Han L et al (2009) Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series. Int J Radiat Oncol Biol Phys 75:1071–1078

    Article  PubMed  Google Scholar 

  • Palazzi M, Orlandi E, Bossi P et al (2009) Further improvement in outcomes of nasopharyngeal carcinoma with optimized radiotherapy and induction plus concomitant chemotherapy: an update of the Milan experience. Int J Radiat Oncol Biol Phys 74:774–780

    Article  PubMed  Google Scholar 

  • Shen C, Lu JJ, Gu Y et al (2008) Prognostic impact of primary tumor volume in patients with nasopharyngeal carcinoma treated by definitive radiation therapy. Laryngoscope 118:1206–1210

    Article  PubMed  Google Scholar 

  • Sobin LH, Wittekind CL (eds) (2002) TNM classification of malignant tumors, 6th edn. Wiley, New York

    Google Scholar 

  • Tham IW, Hee SW, Yeo RM et al (2009) Treatment of nasopharyngeal carcinoma using intensity-modulated radiotherapy-the National Cancer Centre Singapore experience. Int J Radiat Oncol Biol Phys 75:1481–1486

    Article  PubMed  Google Scholar 

  • Wei WI, Sham JS (2005) Nasopharyngeal carcinoma. Lancet 365:2041–2054

    Article  PubMed  Google Scholar 

  • Willner J, Baier K, Pfreundner L et al (1999) Tumor volume and local control in primary radiotherapy of nasopharyngeal carcinoma. Acta Oncol 38:1025–1030

    Article  CAS  PubMed  Google Scholar 

  • Wolden SL, Chen WC, Pfister DG et al (2006) Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys 64:57–62

    Article  PubMed  Google Scholar 

  • Xiao WW, Huang SM, Han F et al (2011) Local control, survival, and late toxicities of locally advanced nasopharyngeal carcinoma treated by simultaneous modulated accelerated radiotherapy combined with cisplatin concurrent chemotherapy: long-term results of a phase 2 study. Cancer 117:1874–1883

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Planned Science and Technology Project of Guangdong Province (No. 2010B080701016 and No. 2012B031800301).

Conflict of interest

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Authors and Affiliations

  1. State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road, East, Guangzhou, 510060, People’s Republic of China

    Yong Su, Mo-Fa Gu & Shao-Min Huang

  2. Department of Radiation Oncology, Tumor Hospital, Xiangya School of Medicine, Central South University, Changsha, 410013, People’s Republic of China

    Zheng Wu

  3. Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    Rui-Fang Zeng

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  1. Zheng Wu
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  2. Yong Su
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  3. Rui-Fang Zeng
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Correspondence to Yong Su.

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Wu, Z., Su, Y., Zeng, RF. et al. Prognostic value of tumor volume for patients with nasopharyngeal carcinoma treated with concurrent chemotherapy and intensity-modulated radiotherapy. J Cancer Res Clin Oncol 140, 69–76 (2014). https://doi.org/10.1007/s00432-013-1542-x

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  • DOI: https://doi.org/10.1007/s00432-013-1542-x

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