Clinical significance of tumor volume and lymph node involvement assessed by MRI in stage IIB cervical cancer patients treated with concurrent chemoradiation therapy

Objective

The purpose of this study was to evaluate the prognostic significance of tumor volume assessed by pretreatment MRI in stage IIB cervical cancer patients with concurrent chemoradiation therapy.

Methods

A retrospective chart review was performed on seventy five patients with cervical cancer who were treated with concurrent weekly cisplatin (40 mg/m²) and radiotherapy between January 2000 and April 2007. Potential prognostic factors were age, chemotherapy numbers, histology, tumor diameter and volume, lymph node (LN) involvement and pretreatment squamous cell carcinoma antigen (SCC-Ag) levels.

Results

The median follow-up time was 55 months (range, 8 to 104 months). The median tumor size and volume (range) were 4.5 cm (2 to 10) and 33.1 mL (4.2 to 392.7), respectively. Pelvic LN enlargement rate was 58.7%. Para-aortic LN enlargement rate was 14.7%. Using multivariate analysis, a tumor volume (>33 mL, p=0.025), pelvic LN enlargement (p=0.044) revealed a significantly unfavorable outcome on overall survival. PFS was influenced by tumor histology (p<0.001), pelvic LN enlargement (p=0.015) and pretreatment SCC-Ag levels (p=0.018). We found that 22 (29.3%) patients had recurrences and 14 (18.7%) patients died of disease. The 5-year overall survival rate was 80.6% (standard error, 4.9%) and 5-year PFS rate was 71.3% (standard error, 5.3%).

Conclusion

Tumor volume and pelvic LN involvement showed possibility to predict overall survival in patient with stage IIB cervical cancer. Optimal tumor volume and pelvic LN assessment by pretreatment MRI might be helpful to predict treatment outcome.     

Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer

Insufficiency fractures are recognised consequences of radiotherapy in gynaecological malignancy with reported incidences between 2.7% and 89%. We aimed to determine the incidence and risk factors for insufficiency fractures in patients receiving radical pelvic radiotherapy for uterine and cervical cancer. A case‐note review was undertaken of patients treated between January 2007 and December 2008. Insufficiency fractures were identified from radiographs, computed tomography and magnetic resonance images. Chi‐squared and Mann–Whitney tests were performed to determine associations between insufficiency fractures and chemotherapy, steroids and age. A total of 285 patients received pelvic radiotherapy, 137 with uterine and 148 with cervical cancer. Mean age was 59 years. A total of 144 patients received chemotherapy, 101 concurrently and 35 adjuvantly. Bone abnormalities affected 67 patients, 33 had pelvic insufficiency fractures, 12 had multiple fractures and 3 patients developed femoral head avascular necrosis. Use of chemotherapy was not associated with development of fractures (P = 0.949). However, cervical cancer patients had a significantly higher incidence of insufficiency fractures (P = 0.018) and bone pain (P = 0.03) compared with uterine cancer patients. This suggests concurrent chemotherapy may be a significant factor in increasing insufficiency fractures and bone morbidity in these patients and highlights a need for further research to identify, prevent and reduce these long‐term complications.     

分段诊刮与核磁共振术前诊断子宫内膜癌宫颈浸润的比较

背景与目的：以往子宫内膜癌宫颈浸润术前诊断依据分段诊断性刮宫得出,而其方法的可靠性受到质疑。因此本文旨在提高术前诊断子宫内膜癌宫颈浸润的准确性,减少手术过治或手术不到位的状况,为制定最佳治疗方案提供依据。方法：术前同时接受分段诊刮（dilatations and curettages,D＆C）和核磁共振成像（MRI）,术后组织病理诊断。其中被任意一项检查方式诊断为宫颈受累的子宫内膜癌患者共34例。分段诊刮、MRI的诊断结果分别与术后组织病理诊断进行比较,比较分析两种方法判断子宫内膜癌宫颈浸润的敏感性、特异性及准确率。结果：34例中手术临床病理分期Ⅱ期即宫颈浸润21例,分段诊刮诊断符合率26.5%、MRI为80%,其敏感性、特异性、准确率MRI显著优于分段诊刮。结论：盆腔MRI并增强检查作为术前判断子宫内膜癌肌层浸润和宫颈浸润之首选,可作为制定治疗方案的可靠依据之一。     

Tumor volume discrepancies between FDG-PET and MRI for cervical cancer

Purpose

To compare the MRI-defined gross tumor volume (MR-GTV) to the metabolic tumor volume (Metabolic GTV) defined by FDG-PET in patients with cervical cancer.

Materials and methods

Forty seven patients with cervical cancer underwent FDG-PET/CT and MRI simulations. FDG-PET images were acquired with a spatial resolution of 5 mm. MR imaging was performed on a 1.5 Tesla scanner. MR-GTV was contoured on the T2 axial images while Metabolic GTV was auto-contoured using a 40% SUV threshold. Tumor volumes were compared.

Results

Eighteen patients (38.3%) had tumors ?62 cc on MRI. Seventeen patients (36.2%) had tumors ?14 and <62 cc, while 12 patients (25.5%) had tumors <14 cc. 83% of patients in the ?62 cc, 23.5% in the 14-62 cc, and 16.7% in the <14 cc cohort had Grade 3 images as defined by Dimopoulos et al. In the ?62 cc cohort, MR-GTV and Metabolic GTV had a lesion coverage factor of 0.68 (mean MR-GTV_vol 124.1, mean Metabolic GTV_vol 119.9 cc). This fell to 0.51 (32.4, 33.1 cc) for the 14-62 cc, and 0.28 (8.4, 8.7 cc) for the <14 cc cohort. These differences were statistically significant on ANOVA testing (p < 0.001).

Conclusions

MRI provided better visualization of larger tumors than smaller tumors in reference to FDG-PET/CT. FDG-PET/CT visualized tumor volumes different from T2-weighted MRI, especially in tumors <14 cc in regard to location.     

Persistent human papillomavirus DNA is associated with local recurrence after radiotherapy of uterine cervical cancer

Human papillomavirus (HPV) DNA is considered as a hallmark of cervical cancer. We investigated whether persistent HPV DNA at the cervix is associated with local recurrence after radiotherapy in patients with locally advanced cervical cancer. A total of 156 patients with HPV-positive cervical cancer (International Federation of Gynecology and Obstetrics stage IB-IVB) treated with radiotherapy between July 2003 and December 2006 were analyzed. HPV DNA was measured prior to radiotherapy and after completion of radiotherapy. The results of HPV DNA test at postradiotherapy 1, 3, 6 and 12 months were analyzed individually for association with local recurrence-free survival (LRFS). In addition, the result of any last follow-up HPV test within 24 months postradiotherapy was defined as the overall status of HPV at 24 months and was also analyzed for association with LRFS. HPV DNA was cleared in 127 patients (81.4%) and persistent in 29 patients (18.6%) by 24 months. In 18 patients with local recurrences, 14 patients (78%) showed positive HPV tests at 1-3 months. Among the various time points analyzed, a positive HPV test at 3 months was the most accurate predictor of local recurrence. Multivariate analysis indicated that overall status of HPV at 24 months, low HPV viral load and histologic grade as being significantly related to poor LRFS. In HPV-positive cervical carcinoma treated primarily with radiotherapy, persistent HPV DNA within 24 months after treatment indicates a high risk of local recurrence. Diagnostic accuracy of HPV test was highest at 3 months.     

Tumor diameter/volume and pelvic node status assessed by magnetic resonance imaging (MRI) for uterine cervical cancer treated with irradiation

PURPOSE: To evaluate the prognostic value of tumor diameter/volume and pelvic node status assessed by magnetic resonance imaging (MRI) in patients with uterine cervical cancer treated with radiation therapy. METHODS AND MATERIALS: Forty-four patients with intact uterine cervical squamous carcinoma treated with a combination of external irradiation and high-dose-rate intracavitary therapy were analyzed. Actuarial disease-free survival (DFS), pelvic control rate (PC), and distant metastasis-free rate (DMF) were analyzed by tumor diameter, volume, and pelvic node status assessed by pretreatment MRI. RESULTS: Anteroposterior (AP) and lateral (RL) tumor diameter significantly affected DFS. The 2-year DFS was 74% for patients with < 40 mm in AP diameter tumor, and 24% for > or = 40 mm tumor (p = 0.02). Whereas PC was not influenced, DMF was significantly affected by AP tumor diameter. Tumor volume did not significantly affect any endpoints. Patients with enlarged pelvic nodes had significantly poorer outcome compared to those with none on PC, DMF, and DFS. The 2-year DFS was 78% for node-negative, and 10% for node-positive patients (p = 0.0001). CONCLUSION: AP tumor diameter and pelvic lymph node status assessed by MRI were the significant prognostic factors in uterine cervical cancer treated with irradiation. Prognostic value of tumor volume should be reassessed prospectively with an appropriate imaging technique. AP tumor diameter predominantly affected the incidence of distant metastasis, and lymph node status affected both pelvic control and distant metastasis.     

顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效分析

目的：比较顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效。方法：38例IIb到IVa期患者随机分为每周顺铂同期放化疗组（22例）或多西紫杉醇同期放化疗组（16例）。顺铂30mg/m2或多西紫杉醇25mg/m2抗过敏预处理,每周放疗的第一天同步静脉滴注,连续6周;放疗方法：两组患者外照射放疗采用直线加速器盆腔大野DT 30Gy后中央挡铅改为盆腔四野加量照射至DT 50Gy,常规分割,180-200cGy/F,盆腔四野照射期间每周局部后装铱192照射一次,每次剂量6Gy,共6次,A点剂量达3600cGy。观察两组治疗效果和不良反应并进行比较。结果：两组患者总有效率82%vs 87%,临床获益率91%vs 94%,差异无统计学意义（P〉0.05）;两组随访1年无进展生存率（PFS）比较77%vs 81%,总生存率（OS）95%vs 100%,差异无统计学意义（P〉0.05）;但多西紫杉醇同期放化组较顺铂同期放化组治疗无论在血液系统不良反应和非血液系统不良反应方面都明显降低,统计学比较差异有显著性P〈0.05。结论：多西紫杉醇同期放化疗可取得不亚于顺铂同期放化治疗的疗效,且多西紫杉醇不良反应明显降低。     

Neoadjuvant chemotherapy followed by radiotherapy and concurrent hyperthermia in patients with advanced-stage cervical cancer: A retrospective study

Objective: To evaluate the efficacy of neoadjuvant chemotherapy, followed by radiotherapy and concurrent hyperthermia (triple therapy) in patients with advanced-stage cervical cancer.

Methods: We selected 43 patients from our hyperthermia database, who were treated from 1996 to 2010 with triple therapy for large primary tumours (>6?cm) or para-aortic lymph node metastases. All patients received platinum-based chemotherapy followed by full-dose radiotherapy, brachytherapy and five hyperthermia treatments. The response was evaluated by gynaecological examination and a CT-scan. Time-to-event variables were estimated using the Kaplan Meier method and the Cox regression method.

Results: The mean age of the patients was 50.4 years (range 29–80). The median tumour size was 5.6?cm at diagnosis (range 2.6–8.2), positive lymph nodes were present in 90.7%. A total of 67% of the patients completed all six planned courses of chemotherapy. After completion of neoadjuvant chemotherapy, 83.7% of patients achieved a complete or partial response. At the end of treatment, the complete response rate was 81.4% (95%CI 69.2–93.5). Grade 2, 3 and 4 acute vascular toxicity occurred in 17 patients. The incidence of grade 3–4 haematological toxicity did not exceed 10% and no neutropenic fever occurred. For grade 1–2 renal toxicity, a switch to carboplatin was made (n?=?6). No acute grade 3–4 renal toxicity was observed. No treatment-related deaths were recorded. The median follow-up time was 29.8 months (range 4.1–124.8). Overall survival rate at 12 months was 79% (95%CI 57.4–92.3).

Conclusion: The triple therapy seems feasible and effective in the treatment of advanced-stage, high-risk cervical cancer. However, chemotherapy-induced vascular toxicity occurred frequently, which may warrant the use of prophylactic anticoagulants. We recommend a phase II trial for prospective confirmation for comparison with standard chemoradiation and the use of anticoagulants.     

顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效分析

目的:比较顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效。方法:38例IIb到IVa期患者随机分为每周顺铂同期放化疗组(22例)或多西紫杉醇同期放化疗组(16例)。顺铂30mg/m2或多西紫杉醇25mg/m2抗过敏预处理,每周放疗的第一天同步静脉滴注,连续6周;放疗方法:两组患者外照射放疗采用直线加速器盆腔大野DT 30Gy后中央挡铅改为盆腔四野加量照射至DT 50Gy,常规分割,180-200cGy/F,盆腔四野照射期间每周局部后装铱192照射一次,每次剂量6Gy,共6次,A点剂量达3600cGy。观察两组治疗效果和不良反应并进行比较。结果:两组患者总有效率82%vs 87%,临床获益率91%vs 94%,差异无统计学意义(P>0.05);两组随访1年无进展生存率(PFS)比较77%vs 81%,总生存率(OS)95%vs 100%,差异无统计学意义(P>0.05);但多西紫杉醇同期放化组较顺铂同期放化组治疗无论在血液系统不良反应和非血液系统不良反应方面都明显降低,统计学比较差异有显著性P<0.05。结论:多西紫杉醇同期放化疗可取得不亚于顺铂同期放化治疗的疗效,且多西紫杉醇不良反应明显降低。     

286例宫颈癌患者放射治疗临床护理效果的观察

目的:探讨加强整体护理对宫颈癌放疗患者并发症的影响效果.方法:对286例宫颈癌患者行体外+腔内放射治疗,根据不同护理计划分为整体护理组100例和整体护理加强组186例,整体护理组是做好常规的以病人为中心的整体护理,加强组除了做好常规的以病人为中心的整体护理外还要加强心理护理、健康教育、饮食护理、并发症及不良反应的预防及护理.对两组放疗并发症的发生率进行比较.结果:两组住院治疗组除整体护理组2例因经济问题出院后在门诊继续行腔内放射治疗外,其余患者均在病房完成放疗计划.共有255例(89.17％)发生骨髓抑制,23例(8.04％)发生阴道并发症,17例(5.94％)发生皮肤病变,8例(2.79％)发生轻、中度放射性直肠炎,3例(1.06％)发生放射性膀胱炎,经保守治疗和药物灌注后,均得到有效控制,好转出院,未发生交叉感染.两组间并发症的发生率比较,整体护理加强组除骨髓抑制外,其他并发症发生率与整体护理组比较均有显著性差异.结论:对宫颈癌放射治疗患者做好加强整体护理措施,安排资深护士精心护理,可减轻患者放射治疗的并发症.     

大孔径MRI模拟定位机引导鼻咽癌靶区勾画的初步研究

目的探讨大孔径MRI模拟定位机在鼻咽癌靶区勾画方面的应用。方法 18例可进行CT及MRI扫描的鼻咽癌患者,分别利用SOMATOM Sensation Open 40排82 cm大孔径CT模拟定位机;西门子3T磁共振系统MAGNETOM Skyra 70 cm大孔径模拟定位机在同一体位下进行CT及MRI扫描定位。按照ICRU 50、62号文件分别进行GTV及腮腺勾画,利用MRI观察GTV及腮腺在放疗过程中体积变化。采用配对t检验分析GTV_CT与GTV_MRIGTV_nx-CT与GTV_nx-MRI差异,GTV_nd-CT与GTV_nd-MRI差异分析采用Wilcoxon检验。结果 GTV_MRI较GTV_CT体积明显缩小,平均体积由(213.64±84.59) cm³缩小至(199.68±84.69) cm³(P=0.006)。鼻咽原发灶GTV_nx-MRI较GTV_nx-CT 缩小,体积由(95.75±24.76) cm³缩小至(88.12±26.25) cm³(P=0.001)。颈部淋巴结GTV_nd-MRI较GTV_nd-CT缩小,体积由(117.89±72.69) cm³缩小至(111.56±70.69) cm³(P=0.018)。且CT及MRI靶区勾画不完全重合,差异主要体现在颅底骨质及颈部软组织方面。MRI引导勾画左右腮腺体积较CT引导勾画左右腮腺体积增大,差异主要体现在腮腺深叶勾画。MRI显示GTV在整个放疗过程中体积缩小约(82.64±16.87)%。左、右腮腺体积分别缩小约(32.7±23.95)%、(34.7±21.72)%。结论 MRI模拟引导勾画靶区较CT模拟勾画靶区更精确,体积范围缩小,有助于进一步精确指导鼻咽癌靶区勾画。     

单纯放射治疗与放化疗联合治疗中晚期宫颈癌的疗效比较

目的对比单纯放疗与放、化疗联合治疗中晚期宫颈癌的疗效。方法按照随机数字表法将105例中晚期患者随机分为观察组(53例)和对照组(52例),对照组给予放射治疗,观察组给予同步放化疗治疗。结果观察组患者的近期疗效及3年生存率均显著高于对照组(P<0.05),观察组患者胃肠道不良反应发生率及骨髓抑制发生率均显著高于对照组(P<0.05)。结论放疗联合化疗治疗中晚期宫颈癌,疗效确切,可有效提高患者生存质量及生存率,值得临床借鉴。     

同步放疗联合介入化疗治疗中晚期子宫颈癌的临床观察

 目的　比较吡柔比星（THP）、5-氟尿嘧啶（5-Fu）联合顺铂（DDP）介入化疗联合放疗与单纯放疗治疗中晚期子宫颈癌的疗效和不良反应。方法　将48例经病理确诊的ⅡB～Ⅳ期子宫颈癌患者按随机数字表法分为同步放疗及介入化疗组（25例）和单纯放疗组（23例）,两组放疗剂量相同,同步放化疗组在放疗前后予以髂内动脉局部介入灌注化疗,THP 30～40 mg、5-Fu 0.50～0.75 g、DDP 40～ 60 mg,28 d为1个周期,共 3～4个周期 。对比两组的治疗效果及相关不良反应。结果　同步放疗及介入化疗组有效率为92.0 %（23／25）,3年生存率80.0 %（20／25）。单纯放疗组有效率为69.6 %（16／23）, 3年生存率为52.2 %（12／23）,两组差异有统计学意义（均P＜0.05）。两组相关不良反应发生率之间差异无统计学意义（均P＞0.05）,经对症处理后可耐受,为可逆的。结论　同步放疗联合介入化疗治疗中、晚期子宫颈癌可显著提高患者有效率及生存率,不良反应与单纯放疗相比无明显增加。     

A phase I-II study of weekly cisplatin and gemcitabine with concurrent radiotherapy in locally advanced cervical carcinoma.

BACKGROUND: The purpose of this study was to determine the maximum-tolerated dose (MTD) and the antitumor activity of gemcitabine when administered in combination with concurrent cisplatin and radiotherapy in locally advanced cervical carcinoma (LACC). PATIENTS AND METHODS: Patients with histologically confirmed LACC (International Federation of Gynecology and Obstetrics IIB-IVA), previously untreated, were eligible for entry in the study to receive radiotherapy and concomitant weekly chemotherapy with cisplatin 40 mg/m(2) and gemcitabine at increasing doses levels until the MTD was found. RESULTS: Thirty-six patients were included. Sixteen patients were entered at four dose levels. The MTD was 150 mg/m(2) and the recommended dose of gemcitabine for phase II was 125 mg/m(2). Twenty additional patients were entered at this level. Toxicity at the recommended dose was acceptable with grade 3/4 toxicity in <20% of patients. Thirty-five of thirty-six patients (97.3%) achieved an objective response, 32 (88.8%) a complete response (CR) three a (8.3%) partial response and one (2.7%) stable disease. At a median follow-up of 26 months, 28 of 36 patients (77.7%) are in sustained complete remission and seven of 36 (19.4%) have relapsed. The 3-year disease-free and overall survival rates are 67% and 72%, respectively. CONCLUSION: The association of cisplatin and gemcitabine with concurrent radiotherapy is active and well-tolerated in untreated LACC.     

调强放疗治疗宫颈癌术后并发无症状盆腔淋巴囊肿的靶区勾画

目的:探讨宫颈癌根治术后并发无症状盆腔淋巴囊肿(pelvic lymphocyst,PL)给予调强放疗(intensity-modulated radiotherapy,IMRT)时勾画临床靶区(clinical target volume,CTV)将PL包括完全的可行性.方法:2015年1月至2016年2月我科收治的宫颈癌根治术后具有放疗指征的患者共90例,模拟定位计算机断层扫描(computed tomography,CT)时发现并发无症状PL的46例患者纳入本研究.每例患者均进行两次CTV勾画,根据CTV是否将淋巴囊肿包括完全分为实验组(46例,将淋巴囊肿包括完全)和对照组(46例,未将淋巴囊肿包括完全),两组均采用同样的IMRT技术制定治疗计划,通过剂量体积直方图(dose volume histogram,DVH)比较两种CTV勾画方式对周围危及器官(organ at risk,OAR)受照剂量体积的影响.结果:实验组CTV体积明显大于对照组,差异具有统计学意义(P<0.05).在IMRT放疗方式中,实验组的小肠、直肠、膀胱受照剂量和体积均高于对照组,但上述差异均不具有统计学意义(P>0.05).结论:宫颈癌根治术后并发无症状PL进行IMRT时,CTV勾画可以将PL全部包括在内,OAR的受照剂量体积并未明显增加.     

Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy: comparison with conventional radiotherapy

PURPOSE: To assess local control and acute and chronic toxicity with intensity-modulated radiation therapy (IMRT) as adjuvant treatment of cervical cancer. METHODS AND MATERIALS: Between April 2002 and February 2006, 68 patients at high risk of cervical cancer after hysterectomy were treated with adjuvant pelvic radiotherapy and concurrent chemotherapy. Adjuvant chemotherapy consisted of cisplatin (50 mg/m(2)) for six cycles every week. Thirty-three patients received adjuvant radiotherapy by IMRT. Before the IMRT series was initiated, 35 other patients underwent conventional four-field radiotherapy (Box-RT). The two groups did not differ significantly in respect of clinicopathologic and treatment factors. RESULTS: IMRT provided compatible local tumor control compared with Box-RT. The actuarial 1-year locoregional control for patients in the IMRT and Box-RT groups was 93% and 94%, respectively. IMRT was well tolerated, with significant reduction in acute gastrointestinal (GI) and genitourinary (GU) toxicities compared with the Box-RT group (GI 36 vs. 80%, p = 0.00012; GU 30 vs. 60%, p = 0.022). Furthermore, the IMRT group had lower rates of chronic GI and GU toxicities than the Box-RT patients (GI 6 vs. 34%, p = 0.002; GU 9 vs. 23%, p = 0.231). CONCLUSION: Our results suggest that IMRT significantly improved the tolerance to adjuvant chemoradiotherapy with compatible locoregional control compared with conventional Box-RT. However, longer follow-up and more patients are needed to confirm the benefits of IMRT.     

适形调强放疗联合紫杉醇和奈达铂化疗治疗颈段和胸上段食管癌

目的：评估紫杉醇和奈达铂联合适形调强放疗治疗颈段和胸上段食管癌的疗效及预后相关因素。方法：回顾性分析32例在本院接受治疗的颈段和胸上段食管癌患者,患者均接受适形调强放疗（IMRT）联合紫杉醇和奈达铂方案（TP 方案）化疗;分析生存率及预后因素。结果：随访率为100％,中位随访时间为16个月,1、2、3年生存率分别为86．4％、63．9％、37．8％,中位无进展生存期为20个月,中位生存期为36个月。单因素分析预后影响因素有疗前进食情况、治疗前 ECOG 评分、食管造影显示病变长度、T 分期、非手术 N 分期、临床分期、近期疗效,Cox 多因素分析显示疗前病变长度、非手术 N 分期为独立预后影响因素。结论：对于颈段和胸上段食管病人,TP 方案联合 IMRT 治疗安全有效,放疗前病变长度短、非手术 N 分期早治疗效果好。     

Tumor volume is not an independent prognostic factor in early-stage nasopharyngeal carcinoma treated by radiotherapy alone

PURPOSE: To determine whether the tumor volume can predict the treatment outcome in early-stage nasopharyngeal carcinoma (NPC) treated by radiotherapy alone. METHODS AND MATERIALS: The pretreatment CT scans of 116 patients with American Joint Committee on Cancer Stage I-II NPC treated by radiotherapy alone were retrospectively reviewed. The clinician outlined the tumor extent. The primary tumor volume (PTV) and nodal volume (NV) were then calculated by a summation-of-areas technique. The PTV and NV were correlated with locoregional control, distant failure, and survival. The median follow-up time was 105 months. RESULTS: Patients with Stage I disease had a 5-year locoregional control rate of 95% and a disease-specific survival (DSS) rate of 97%; for Stage II disease, the corresponding rates were 81% and 79%. The PTV ranged from 1.3 to 75.5 cm3 (median, 12.6 cm3), with substantial overlap between T1 and T2 disease. The NV ranged from 0 to 35.4 cm(3). Patients with a PTV >15 cm3 had significantly worse local control (5-year control rate, 82% vs. 93%; p = 0.033), but no statistically significant difference was noted in survival (5-year DSS rate, 83% vs. 89%; p = 0.30). The difference in local control was mainly seen in those with T2 disease. Patients with NV >4 cm3 had a greater distant failure rate (5-year distant metastasis-free rate, 72% vs. 90%; p = 0.011) and worse survival (5-year DSS rate, 76% vs. 94%; p = 0.0038). Nodal control was excellent with no difference between a NV of < or =4 cm3 and a NV of >4 cm3 (5-year control rate, 97% vs. 100%). The survival rate was worst in patients with a PTV >15 cm3 and a NV >4 cm3 (5-year DSS rate, 68%) and best in those with a PTV of < or =15 cm3 and a NV of < or =4 cm3 (5-year DSS rate, 92%). Multivariate analysis, however, showed that only parapharyngeal extension (T2b) and N1 stage were independent factors that predicted locoregional control and survival, and N1 stage was the only factor that predicted distant failure. CONCLUSION: The pretreatment tumor volume has a limited prognostic value in early-stage NPC compared with the usual T and N classification, with Stage T2b and N1 as independent factors that predicted treatment outcome. Within T2 disease, the estimation of tumor volume may identify a subgroup of patients with a greater risk of local failure that warrants more aggressive treatment.