Radiotherapy 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy.
Future Oncol. 2013 Jan;9(1):103-14. doi: 10.2217/fon.12.166.
To analyze the patterns of locoregional failure following intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) at our institution, as part of an internal quality assurance program. We aimed to investigate the potential existence of a correlation between any part of the IMRT process and clinical outcome.
METHODS & MATERIALS: A total of 106 non-metastatic NPC patients consecutively treated with IMRT (with or without chemotherapy) were analyzed. Radiotherapy was administered using a sequential or simultaneous integrated boost approach at the total prescribed dose of 66-70 Gy (2.00-2.12 Gy per fraction). MRI studies of recurrences were recorded with the planning computed tomography studies to identify volume of failure. Recurrence-related characteristics were analyzed with respect to the original treatment. Failures were classified as 'in-field', 'marginal' or 'out-field' if at least 95, 20-95 or less than 20% of the volume of failure, respectively, was within 95% of the total prescription dose.
With a median follow-up of 43.4 months, 5-years local control, regional control, locoregional control and overall survival rates were 87.7, 88.0, 83.5 and 81.3% respectively. A total of 21 failures were registered in 15 patients. In particular, ten failures (47.6%) were classified as 'in-field' (seven local failures and three regional failures [RFs]), nine failures (42.9%) as 'marginal' (five local failures and four RFs) and only two failures (9.5%) as 'out-field' (both RFs). The most relevant causes of failures were suboptimal target definition and target coverage as well as a longer than planned overall treatment time.
IMRT determines excellent outcome in NPC patients. However, great attention in all IMRT steps is necessary to reduce potential causes of failure.
作为内部质量保证计划的一部分，分析本机构接受调强放疗（IMRT）治疗的鼻咽癌（NPC）患者局部区域失败的模式。我们旨在研究 IMRT 过程的任何部分与临床结果之间是否存在相关性。
共分析了 106 例连续接受 IMRT（伴或不伴化疗）治疗的非转移性 NPC 患者。放疗采用序贯或同步整合升压方法，总处方剂量为 66-70Gy（2.00-2.12Gy/次）。将 MRI 研究中的复发情况与计划 CT 研究记录下来，以确定失败的体积。根据原始治疗分析复发相关特征。如果失败体积的至少 95%、20%-95%或不到 20%分别位于 95%总处方剂量内，则将失败分类为“场内”、“边缘”或“场外”。
中位随访 43.4 个月后，5 年局部控制、区域控制、局部区域控制和总生存率分别为 87.7%、88.0%、83.5%和 81.3%。共有 15 名患者中出现 21 例失败。具体而言，10 例失败（47.6%）被归类为“场内”（7 例局部失败和 3 例区域失败[RF]），9 例失败（42.9%）为“边缘”（5 例局部失败和 4 例 RF），仅 2 例失败（9.5%）为“场外”（均为 RF）。失败的最主要原因是靶区定义和靶区覆盖不理想，以及总治疗时间长于计划时间。
IMRT 为 NPC 患者带来了优异的结果。然而，在所有 IMRT 步骤中都需要高度关注，以减少潜在的失败原因。
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