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Improved local control with intensity modulated radiation therapy in patients with nasopharyngeal carcinoma
Proceedings of the 46th Annual ASTRO Meeting
1102
Improved Local Control with Intensity Modulated Radiation Therapy in Patients with Nasopharyngeal Carcinoma
Z. Chong1 Radiation Therapy, Cancer Center of SUN Yat-sen University, Guangzhou, Guang Dong, China
1
Purpose/Objective: To study the efficacy and toxicity of intensity modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC). Materials/Methods: One hundred and four patients with nasopharyngeal carcinoma were accrued in this study from Jan. 2001 to Aug. 2004 at the Sun Yat-sen University Cancer Center. There were twenty-four females and eighty males, with a mean age of 42.5 (range 19 –73). According to the AJCC Stage Classification, the disease was Stage I in 8 (7.69%), Stage II in 44 (42.31%), Stage III in 35 (33.65%), Stage IVa in 14 (13.46%), and Stage IVb in 3 (2.88%). IMRT method was carried out using an inverse planning system (CORVUS 3.0, Peacock plan) developed by the NOMOS Corp. Treatment was delivered with the Multi-leaf Intensity Modulating Collimator (MIMiC) using a slice-by-slice arc rotation approach. The prescription dose was 64-70Gy/25–30f to the nasopharynx gross target volume (GTVnx) and 60-66Gy/25–30f to the positive neck lymph nodes (GTVnd), and 55-66Gy/25–30f to the volume (Target 1), which was 5–10mm in the superior, inferior, anterior and lateral directions and 2–3mm in the posterior direction beside the GTVnx, and 42-54Gy/25–30f to the volume (Target 2), which was 5–10mm in the superior, inferior, anterior and lateral directions and 2–3mm in the posterior direction beside the Target 1 and included negative neck. The GTVnx and upper neck were irradiated using the IMRT techniques. The lower neck and the supraclavicular fossae were irradiated with a conventional technique using an anterior field. 24 (23.08%) patients received cisplatin and 5-fluorouracil before, or during and after radiotherapy. Acute toxicities were graded according to the RTOG radiation morbidity scoring criteria. The parotid function of some patients was examined by SPECT at the beginning, end, and 1-year after therapy. The Kaplan-Meier method was used to calculate actuarial rates of local-regional progression-free, distant metastasis-free survival, and overall survival from the last date of therapy. Results: Analyses of the dose-volume histograms showed that the average maximum, minimum, and mean dose were 77.14Gy, 62.22Gy, and 71.31Gy deliver to the GTVnx, 71.77Gy, 60.35Gy, and 66.26Gy to the GTVnd, 76.25Gy, 54.53Gy, and 67.72Gy to the Target 1, 74.51Gy, 41.76Gy, and 61.68Gy to the Target 2, respectively. The V95 were 99.35%, 99.93%, 99.75%, and 99.49% for the GTVnx, GTVnd, Target 1, and Target 2, respectively. The average dose to 5% of the brain stem and 1cc of the cervical spinal cord were 46.53Gy and 39.49Gy, respectively. The average dose to 33% of the right and left parotid glands and T-M joints were 36.72Gy, 36.47Gy and 34.57Gy, 34.49Gy, respectively. The grade 0, 1, 2 and 3 acute toxicities were 0, 79, 23 and 2 cases in skin, 0, 26, 61 and 17 cases in mucous, and 5, 45, 53 and 1 cases in salivary gland, respectively. With a median followed-up of 19 months (range 7 to 36 months), there has been one regional recurrence at the lower neck. Ten patients developed distant metastases, seven of these patients have died. The 3-year estimates of local progression-free, regional progression-free, and distant metastases-free rates were 98.46%, 99.04%, and 87.57% respectively. The 3-year estimate of overall survival rate was 86.25%. The parotid function was examined by SPECT in 32 patients. At the end of therapy, there were 0, 3, 6, 2, 20 cases and 5, 3, 3, 0, 21 cases in grade 0, 1, 2, 3, 4 in the left and right parotid respectively. At 1-year after therapy, 15 cases had grade 0, 6 had grade 1, 5 had grade 2, 5 had grade 3, and 3 had grade 4 in the left parotid respectively, 9 cases had grade 0, 6 had grade 1, 7 had grade 2, 6 had grade 3, and 4 had grade 4 in the right parotid respectively. The most of damaged parotid function had recovered with time. Conclusions: IMRT provided improved target volume coverage and increased dose to the GTVs with significant sparing of the normal tissues. Excellent local-regional control for NPC was achieved. However, the study will continue to decrease the distant metastasis rate.
1103
Intensity Modulated Radiation Therapy for Carcinoma of the Nasopharynx: An Update of the UCSF Experience
M. Bucci,1 P. Xia,1 N. Lee,2 N. Fishbein,3 A. Kramer,4 V. Weinberg,1 C. Akazawa,1 A. Cabrera,5 K. K. Fu,1 J. M. Quivey1 Radiation Oncology, UCSF, San Francisco, CA, 2Radiation Oncology, MSKCC, New York, NY, 3Radiology, UCSF, San Francisco, CA, 4Medicine, UCSF, San Francisco, CA, 5School of Medicine, UCSF, San Francisco, CA
1
Purpose/Objective: Initial reports using intensity modulated radiation therapy (IMRT) in nasopharynx cancer (NPC) have shown excellent loco-regional control and survival. This study updates our previous experience including an additional 51 patients. Materials/Methods: Between April 1995 and October 2003, 118 patients underwent IMRT for NPC at the University of California, San Francisco (UCSF). This series includes 38 patients treated with forward planned IMRT, 15 treated with sequential tomotherapy using a dynamic multivane intensity modulating collimator (MIMiC), and 65 treated with multileaf collimator (MLC) based plans. Early techniques required matched conventional fields to the upper and/or lower neck. In 2002 we implemented an extended field, single isocenter IMRT technique that includes the entire target volumes. Our typical prescription dose is 70 Gy to the GTV in 2.12 Gy fractions, 60 Gy to CTV1 in 1.8 Gy fractions, and 54 Gy to the CTV2 in 1.65 Gy fractions. Twenty-six patients had fractionated high-dose-rate intracavitary brachytherapy boost of 5–7 Gy in 2 fractions and 1 patient had gamma knife radiosurgery boost. One hundred six patients received concurrent platinum-based chemotherapy. The local progression-free, regional progression-free, distant metastasis-free rates, and the overall survival were calculated using the Kaplan-Meier method. Results: Our series includes 31 females and 87 males, with a mean age of 52 (range 16 - 82). The disease was stage I in 12 patients, stage IIA in 1, stage IIB in 17, stage III in 49, stage IVA in 26, and stage IVB in 12. Analysis of the dose-volume histograms (DVHs) of patients treated with inverse plans shows that the average maximum, mean, and minimum point doses delivered were 79.7Gy, 73.0 Gy, and 58.2 Gy to the GTV, and 79.7 Gy, 68.2 Gy, and 37.8 Gy to the CTV1. An average of 3.68% of the GTV and 3.84 % of the CTV received less than 95% of the prescribed dose. Average maximum spinal cord and brain stem doses were 42.8 Gy and 54.0 Gy, respectively. The average mean parotid dose was 26.9 Gy. With a median follow-up of 30.2 months, there have been a total of six failures; four at the primary site and two in the neck. The primary site failures, including the single patient in our series who received part of his treatment with opposed lateral fields at an outside hospital, occurred at 31, 41, 60 and 65 months from diagnosis. There were no marginal failures; all four were in the GTV. Three
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1102
Improved Local Control with Intensity Modulated Radiation Therapy in Patients with Nasopharyngeal Carcinoma
Z. Chong1 Radiation Therapy, Cancer Center of SUN Yat-sen University, Guangzhou, Guang Dong, China
1
Purpose/Objective: To study the efficacy and toxicity of intensity modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC). Materials/Methods: One hundred and four patients with nasopharyngeal carcinoma were accrued in this study from Jan. 2001 to Aug. 2004 at the Sun Yat-sen University Cancer Center. There were twenty-four females and eighty males, with a mean age of 42.5 (range 19 –73). According to the AJCC Stage Classification, the disease was Stage I in 8 (7.69%), Stage II in 44 (42.31%), Stage III in 35 (33.65%), Stage IVa in 14 (13.46%), and Stage IVb in 3 (2.88%). IMRT method was carried out using an inverse planning system (CORVUS 3.0, Peacock plan) developed by the NOMOS Corp. Treatment was delivered with the Multi-leaf Intensity Modulating Collimator (MIMiC) using a slice-by-slice arc rotation approach. The prescription dose was 64-70Gy/25–30f to the nasopharynx gross target volume (GTVnx) and 60-66Gy/25–30f to the positive neck lymph nodes (GTVnd), and 55-66Gy/25–30f to the volume (Target 1), which was 5–10mm in the superior, inferior, anterior and lateral directions and 2–3mm in the posterior direction beside the GTVnx, and 42-54Gy/25–30f to the volume (Target 2), which was 5–10mm in the superior, inferior, anterior and lateral directions and 2–3mm in the posterior direction beside the Target 1 and included negative neck. The GTVnx and upper neck were irradiated using the IMRT techniques. The lower neck and the supraclavicular fossae were irradiated with a conventional technique using an anterior field. 24 (23.08%) patients received cisplatin and 5-fluorouracil before, or during and after radiotherapy. Acute toxicities were graded according to the RTOG radiation morbidity scoring criteria. The parotid function of some patients was examined by SPECT at the beginning, end, and 1-year after therapy. The Kaplan-Meier method was used to calculate actuarial rates of local-regional progression-free, distant metastasis-free survival, and overall survival from the last date of therapy. Results: Analyses of the dose-volume histograms showed that the average maximum, minimum, and mean dose were 77.14Gy, 62.22Gy, and 71.31Gy deliver to the GTVnx, 71.77Gy, 60.35Gy, and 66.26Gy to the GTVnd, 76.25Gy, 54.53Gy, and 67.72Gy to the Target 1, 74.51Gy, 41.76Gy, and 61.68Gy to the Target 2, respectively. The V95 were 99.35%, 99.93%, 99.75%, and 99.49% for the GTVnx, GTVnd, Target 1, and Target 2, respectively. The average dose to 5% of the brain stem and 1cc of the cervical spinal cord were 46.53Gy and 39.49Gy, respectively. The average dose to 33% of the right and left parotid glands and T-M joints were 36.72Gy, 36.47Gy and 34.57Gy, 34.49Gy, respectively. The grade 0, 1, 2 and 3 acute toxicities were 0, 79, 23 and 2 cases in skin, 0, 26, 61 and 17 cases in mucous, and 5, 45, 53 and 1 cases in salivary gland, respectively. With a median followed-up of 19 months (range 7 to 36 months), there has been one regional recurrence at the lower neck. Ten patients developed distant metastases, seven of these patients have died. The 3-year estimates of local progression-free, regional progression-free, and distant metastases-free rates were 98.46%, 99.04%, and 87.57% respectively. The 3-year estimate of overall survival rate was 86.25%. The parotid function was examined by SPECT in 32 patients. At the end of therapy, there were 0, 3, 6, 2, 20 cases and 5, 3, 3, 0, 21 cases in grade 0, 1, 2, 3, 4 in the left and right parotid respectively. At 1-year after therapy, 15 cases had grade 0, 6 had grade 1, 5 had grade 2, 5 had grade 3, and 3 had grade 4 in the left parotid respectively, 9 cases had grade 0, 6 had grade 1, 7 had grade 2, 6 had grade 3, and 4 had grade 4 in the right parotid respectively. The most of damaged parotid function had recovered with time. Conclusions: IMRT provided improved target volume coverage and increased dose to the GTVs with significant sparing of the normal tissues. Excellent local-regional control for NPC was achieved. However, the study will continue to decrease the distant metastasis rate.
1103
Intensity Modulated Radiation Therapy for Carcinoma of the Nasopharynx: An Update of the UCSF Experience
M. Bucci,1 P. Xia,1 N. Lee,2 N. Fishbein,3 A. Kramer,4 V. Weinberg,1 C. Akazawa,1 A. Cabrera,5 K. K. Fu,1 J. M. Quivey1 Radiation Oncology, UCSF, San Francisco, CA, 2Radiation Oncology, MSKCC, New York, NY, 3Radiology, UCSF, San Francisco, CA, 4Medicine, UCSF, San Francisco, CA, 5School of Medicine, UCSF, San Francisco, CA
1
Purpose/Objective: Initial reports using intensity modulated radiation therapy (IMRT) in nasopharynx cancer (NPC) have shown excellent loco-regional control and survival. This study updates our previous experience including an additional 51 patients. Materials/Methods: Between April 1995 and October 2003, 118 patients underwent IMRT for NPC at the University of California, San Francisco (UCSF). This series includes 38 patients treated with forward planned IMRT, 15 treated with sequential tomotherapy using a dynamic multivane intensity modulating collimator (MIMiC), and 65 treated with multileaf collimator (MLC) based plans. Early techniques required matched conventional fields to the upper and/or lower neck. In 2002 we implemented an extended field, single isocenter IMRT technique that includes the entire target volumes. Our typical prescription dose is 70 Gy to the GTV in 2.12 Gy fractions, 60 Gy to CTV1 in 1.8 Gy fractions, and 54 Gy to the CTV2 in 1.65 Gy fractions. Twenty-six patients had fractionated high-dose-rate intracavitary brachytherapy boost of 5–7 Gy in 2 fractions and 1 patient had gamma knife radiosurgery boost. One hundred six patients received concurrent platinum-based chemotherapy. The local progression-free, regional progression-free, distant metastasis-free rates, and the overall survival were calculated using the Kaplan-Meier method. Results: Our series includes 31 females and 87 males, with a mean age of 52 (range 16 - 82). The disease was stage I in 12 patients, stage IIA in 1, stage IIB in 17, stage III in 49, stage IVA in 26, and stage IVB in 12. Analysis of the dose-volume histograms (DVHs) of patients treated with inverse plans shows that the average maximum, mean, and minimum point doses delivered were 79.7Gy, 73.0 Gy, and 58.2 Gy to the GTV, and 79.7 Gy, 68.2 Gy, and 37.8 Gy to the CTV1. An average of 3.68% of the GTV and 3.84 % of the CTV received less than 95% of the prescribed dose. Average maximum spinal cord and brain stem doses were 42.8 Gy and 54.0 Gy, respectively. The average mean parotid dose was 26.9 Gy. With a median follow-up of 30.2 months, there have been a total of six failures; four at the primary site and two in the neck. The primary site failures, including the single patient in our series who received part of his treatment with opposed lateral fields at an outside hospital, occurred at 31, 41, 60 and 65 months from diagnosis. There were no marginal failures; all four were in the GTV. Three
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