Update report of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy and hypothesis of the optimal margin |
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Authors: | Shaojun Lin Jianji Pan Lu Han Qiaojuan Guo Cairong Hu Jingfeng Zong Xiuchun Zhang Jiade Jay Lu |
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Institution: | 1. Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, China;2. Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China;3. Shanghai Proton and Heavy Ion Center, Shanghai, China;4. Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, China |
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Abstract: | Background and purposeTo establish the minimally required margins in different directions measured from GTV in the definitive treatment of nasopharyngeal carcinoma (NPC) using IMRT based on the 5-year results.Methods and materialsBetween November 2003 and May 2007, 414 patients with non-metastatic NPC were treated with IMRT according to our institutional protocol. Treatment outcomes at 5 years were analyzed. Distances from GTV-T to CTV2 (i.e., CTV 59.4 Gy) in 6 directions (anterior, posterior, superior, inferior, and bilateral) were measured and analyzed.ResultsThe 5-year estimated overall survival (OS), disease free survival (DFS), local control (LC) were 80%, 77% and 95%, respectively. For the margins measured from GTV-T to CTV2, margins used with T4 disease were significantly and uniformly smaller than the whole group in all the 6 directions (P = 0.000, 0.000, 0.000, 0.000 and 0.046, respectively). However, no increase of local recurrence was associated to this limited margins used.ConclusionsOur 5-years’ experience showed a very high LC rate. The strategy we used for CTV delineation was safe and reliable. Determined CTV through GTV expansion to a minimally required margin, using GTV + margin (used in our T4 patients) + the whole nasopharyngeal mucosa, especially for the patients with early T disease, might be feasible. |
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Keywords: | Nasopharyngeal carcinoma Intensity-modulated radiation therapy IMRT Radiotherapy Chemoradiation Optimal margins |
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