10-Year Results of Therapeutic Ratio by Intensity-Modulated Radiotherapy Versus Two-Dimensional Radiotherapy in Patients with Nasopharyngeal Carcinoma

Lei Chen, Yuan Zhang, Shu Zhen Lai, Wen Fei Li, Wei Han Hu, Rui Sun, Li Zhi Liu, Fan Zhang, Hao Peng, Xiao Jing Du, Ai Hua Lin, Ying Sun, Jun Ma

Research output: Contribution to journalArticle

Abstract

Background: The purpose of this study was to verify 10-year results of survival and late toxicities and assess the ultimate therapeutic ratio of intensity-modulated radiotherapy (IMRT) versus two-dimensional radiotherapy (2DRT) in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: We retrospectively reviewed the data from 1,276 patients with nonmetastatic NPC who received IMRT or 2DRT from January 2003 to December 2006. Results: Of the 1,276 patients, 512 were treated with IMRT and 764 with 2DRT. Median follow-up was 115 months. At 10 years, the IMRT group demonstrated significantly better results than the 2DRT group in local failure-free survival (L-FFS; 90% vs. 84%; hazard ratio [HR], 0.57, 95% confidence interval [CI], 0.40–0.81; p =.001), failure-free survival (FFS; 69% vs. 58%; HR, 0.69, 95% CI, 0.57–0.83; p <.001), and overall survival (OS; 75% vs. 63%; HR, 0.62, 95% CI, 0.51–0.77; p <.001). Subgroup multivariate analyses showed that radiotherapeutic technique (IMRT vs. 2DRT) remained an independent prognostic factor for L-FFS in the T1 subgroup (HR, 0.30; 95% CI, 0.11–0.80; p =.02); for FFS in the stage II subgroup (HR, 0.42; 95% CI, 0.24–0.73; p =.002); and for OS in the stage I (HR, 0.20; 95% CI, 0.04–0.96; p =.04), stage II (HR, 0.39; 95% CI, 0.21–0.75; p =.004), and stage IVA–B (HR, 0.74, 95% CI, 0.56–0.98; p =.04) subgroups. The incidence of grade 3–4 temporal lobe necrosis, cranial neuropathy, eye damage, ear damage, neck soft tissue damage, trismus, and dry mouth was significantly lower in the IMRT group than in the 2DRT group. Conclusion: IMRT demonstrated an improved ultimate therapeutic ratio compared with 2DRT in patients with NPC after a 10-year follow-up, with significant improvement of L-FFS, FFS, and OS and decrease in most late toxicities. Implications for Practice: The ultimate therapeutic ratio of intensity-modulated radiotherapy versus two-dimensional radiotherapy in patients with nasopharyngeal carcinoma is unclear. In this retrospective study of 1,276 patients with nonmetastatic nasopharyngeal carcinoma with a follow-up of 115 months, intensity-modulated radiotherapy demonstrated an improved ultimate therapeutic ratio compared with two-dimensional radiotherapy, with significant improvement of local failure-free survival, failure-free survival, and overall survival and decrease in most late toxicities and noncancer deaths. However, distant control remains insufficient with this treatment modality.

LanguageEnglish (US)
JournalOncologist
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Intensity-Modulated Radiotherapy
Radiotherapy
Confidence Intervals
Survival
Therapeutics
Trismus
Nasopharyngeal carcinoma
Cranial Nerve Diseases
Temporal Lobe
Ear
Mouth
Necrosis
Neck
Multivariate Analysis
Retrospective Studies

Keywords

  • 10-year results
  • Intensity-modulated radiotherapy
  • Nasopharyngeal carcinoma
  • Therapeutic ratio
  • Two-dimensional radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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10-Year Results of Therapeutic Ratio by Intensity-Modulated Radiotherapy Versus Two-Dimensional Radiotherapy in Patients with Nasopharyngeal Carcinoma. / Chen, Lei; Zhang, Yuan; Lai, Shu Zhen; Li, Wen Fei; Hu, Wei Han; Sun, Rui; Liu, Li Zhi; Zhang, Fan; Peng, Hao; Du, Xiao Jing; Lin, Ai Hua; Sun, Ying; Ma, Jun.

In: Oncologist, 01.01.2018.

Research output: Contribution to journalArticle

Chen, Lei ; Zhang, Yuan ; Lai, Shu Zhen ; Li, Wen Fei ; Hu, Wei Han ; Sun, Rui ; Liu, Li Zhi ; Zhang, Fan ; Peng, Hao ; Du, Xiao Jing ; Lin, Ai Hua ; Sun, Ying ; Ma, Jun. / 10-Year Results of Therapeutic Ratio by Intensity-Modulated Radiotherapy Versus Two-Dimensional Radiotherapy in Patients with Nasopharyngeal Carcinoma. In: Oncologist. 2018.
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abstract = "Background: The purpose of this study was to verify 10-year results of survival and late toxicities and assess the ultimate therapeutic ratio of intensity-modulated radiotherapy (IMRT) versus two-dimensional radiotherapy (2DRT) in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: We retrospectively reviewed the data from 1,276 patients with nonmetastatic NPC who received IMRT or 2DRT from January 2003 to December 2006. Results: Of the 1,276 patients, 512 were treated with IMRT and 764 with 2DRT. Median follow-up was 115 months. At 10 years, the IMRT group demonstrated significantly better results than the 2DRT group in local failure-free survival (L-FFS; 90{\%} vs. 84{\%}; hazard ratio [HR], 0.57, 95{\%} confidence interval [CI], 0.40–0.81; p =.001), failure-free survival (FFS; 69{\%} vs. 58{\%}; HR, 0.69, 95{\%} CI, 0.57–0.83; p <.001), and overall survival (OS; 75{\%} vs. 63{\%}; HR, 0.62, 95{\%} CI, 0.51–0.77; p <.001). Subgroup multivariate analyses showed that radiotherapeutic technique (IMRT vs. 2DRT) remained an independent prognostic factor for L-FFS in the T1 subgroup (HR, 0.30; 95{\%} CI, 0.11–0.80; p =.02); for FFS in the stage II subgroup (HR, 0.42; 95{\%} CI, 0.24–0.73; p =.002); and for OS in the stage I (HR, 0.20; 95{\%} CI, 0.04–0.96; p =.04), stage II (HR, 0.39; 95{\%} CI, 0.21–0.75; p =.004), and stage IVA–B (HR, 0.74, 95{\%} CI, 0.56–0.98; p =.04) subgroups. The incidence of grade 3–4 temporal lobe necrosis, cranial neuropathy, eye damage, ear damage, neck soft tissue damage, trismus, and dry mouth was significantly lower in the IMRT group than in the 2DRT group. Conclusion: IMRT demonstrated an improved ultimate therapeutic ratio compared with 2DRT in patients with NPC after a 10-year follow-up, with significant improvement of L-FFS, FFS, and OS and decrease in most late toxicities. Implications for Practice: The ultimate therapeutic ratio of intensity-modulated radiotherapy versus two-dimensional radiotherapy in patients with nasopharyngeal carcinoma is unclear. In this retrospective study of 1,276 patients with nonmetastatic nasopharyngeal carcinoma with a follow-up of 115 months, intensity-modulated radiotherapy demonstrated an improved ultimate therapeutic ratio compared with two-dimensional radiotherapy, with significant improvement of local failure-free survival, failure-free survival, and overall survival and decrease in most late toxicities and noncancer deaths. However, distant control remains insufficient with this treatment modality.",
keywords = "10-year results, Intensity-modulated radiotherapy, Nasopharyngeal carcinoma, Therapeutic ratio, Two-dimensional radiotherapy",
author = "Lei Chen and Yuan Zhang and Lai, {Shu Zhen} and Li, {Wen Fei} and Hu, {Wei Han} and Rui Sun and Liu, {Li Zhi} and Fan Zhang and Hao Peng and Du, {Xiao Jing} and Lin, {Ai Hua} and Ying Sun and Jun Ma",
year = "2018",
month = "1",
day = "1",
doi = "10.1634/theoncologist.2017-0577",
language = "English (US)",
journal = "Oncologist",
issn = "1083-7159",
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TY - JOUR

T1 - 10-Year Results of Therapeutic Ratio by Intensity-Modulated Radiotherapy Versus Two-Dimensional Radiotherapy in Patients with Nasopharyngeal Carcinoma

AU - Chen, Lei

AU - Zhang, Yuan

AU - Lai, Shu Zhen

AU - Li, Wen Fei

AU - Hu, Wei Han

AU - Sun, Rui

AU - Liu, Li Zhi

AU - Zhang, Fan

AU - Peng, Hao

AU - Du, Xiao Jing

AU - Lin, Ai Hua

AU - Sun, Ying

AU - Ma, Jun

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The purpose of this study was to verify 10-year results of survival and late toxicities and assess the ultimate therapeutic ratio of intensity-modulated radiotherapy (IMRT) versus two-dimensional radiotherapy (2DRT) in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: We retrospectively reviewed the data from 1,276 patients with nonmetastatic NPC who received IMRT or 2DRT from January 2003 to December 2006. Results: Of the 1,276 patients, 512 were treated with IMRT and 764 with 2DRT. Median follow-up was 115 months. At 10 years, the IMRT group demonstrated significantly better results than the 2DRT group in local failure-free survival (L-FFS; 90% vs. 84%; hazard ratio [HR], 0.57, 95% confidence interval [CI], 0.40–0.81; p =.001), failure-free survival (FFS; 69% vs. 58%; HR, 0.69, 95% CI, 0.57–0.83; p <.001), and overall survival (OS; 75% vs. 63%; HR, 0.62, 95% CI, 0.51–0.77; p <.001). Subgroup multivariate analyses showed that radiotherapeutic technique (IMRT vs. 2DRT) remained an independent prognostic factor for L-FFS in the T1 subgroup (HR, 0.30; 95% CI, 0.11–0.80; p =.02); for FFS in the stage II subgroup (HR, 0.42; 95% CI, 0.24–0.73; p =.002); and for OS in the stage I (HR, 0.20; 95% CI, 0.04–0.96; p =.04), stage II (HR, 0.39; 95% CI, 0.21–0.75; p =.004), and stage IVA–B (HR, 0.74, 95% CI, 0.56–0.98; p =.04) subgroups. The incidence of grade 3–4 temporal lobe necrosis, cranial neuropathy, eye damage, ear damage, neck soft tissue damage, trismus, and dry mouth was significantly lower in the IMRT group than in the 2DRT group. Conclusion: IMRT demonstrated an improved ultimate therapeutic ratio compared with 2DRT in patients with NPC after a 10-year follow-up, with significant improvement of L-FFS, FFS, and OS and decrease in most late toxicities. Implications for Practice: The ultimate therapeutic ratio of intensity-modulated radiotherapy versus two-dimensional radiotherapy in patients with nasopharyngeal carcinoma is unclear. In this retrospective study of 1,276 patients with nonmetastatic nasopharyngeal carcinoma with a follow-up of 115 months, intensity-modulated radiotherapy demonstrated an improved ultimate therapeutic ratio compared with two-dimensional radiotherapy, with significant improvement of local failure-free survival, failure-free survival, and overall survival and decrease in most late toxicities and noncancer deaths. However, distant control remains insufficient with this treatment modality.

AB - Background: The purpose of this study was to verify 10-year results of survival and late toxicities and assess the ultimate therapeutic ratio of intensity-modulated radiotherapy (IMRT) versus two-dimensional radiotherapy (2DRT) in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: We retrospectively reviewed the data from 1,276 patients with nonmetastatic NPC who received IMRT or 2DRT from January 2003 to December 2006. Results: Of the 1,276 patients, 512 were treated with IMRT and 764 with 2DRT. Median follow-up was 115 months. At 10 years, the IMRT group demonstrated significantly better results than the 2DRT group in local failure-free survival (L-FFS; 90% vs. 84%; hazard ratio [HR], 0.57, 95% confidence interval [CI], 0.40–0.81; p =.001), failure-free survival (FFS; 69% vs. 58%; HR, 0.69, 95% CI, 0.57–0.83; p <.001), and overall survival (OS; 75% vs. 63%; HR, 0.62, 95% CI, 0.51–0.77; p <.001). Subgroup multivariate analyses showed that radiotherapeutic technique (IMRT vs. 2DRT) remained an independent prognostic factor for L-FFS in the T1 subgroup (HR, 0.30; 95% CI, 0.11–0.80; p =.02); for FFS in the stage II subgroup (HR, 0.42; 95% CI, 0.24–0.73; p =.002); and for OS in the stage I (HR, 0.20; 95% CI, 0.04–0.96; p =.04), stage II (HR, 0.39; 95% CI, 0.21–0.75; p =.004), and stage IVA–B (HR, 0.74, 95% CI, 0.56–0.98; p =.04) subgroups. The incidence of grade 3–4 temporal lobe necrosis, cranial neuropathy, eye damage, ear damage, neck soft tissue damage, trismus, and dry mouth was significantly lower in the IMRT group than in the 2DRT group. Conclusion: IMRT demonstrated an improved ultimate therapeutic ratio compared with 2DRT in patients with NPC after a 10-year follow-up, with significant improvement of L-FFS, FFS, and OS and decrease in most late toxicities. Implications for Practice: The ultimate therapeutic ratio of intensity-modulated radiotherapy versus two-dimensional radiotherapy in patients with nasopharyngeal carcinoma is unclear. In this retrospective study of 1,276 patients with nonmetastatic nasopharyngeal carcinoma with a follow-up of 115 months, intensity-modulated radiotherapy demonstrated an improved ultimate therapeutic ratio compared with two-dimensional radiotherapy, with significant improvement of local failure-free survival, failure-free survival, and overall survival and decrease in most late toxicities and noncancer deaths. However, distant control remains insufficient with this treatment modality.

KW - 10-year results

KW - Intensity-modulated radiotherapy

KW - Nasopharyngeal carcinoma

KW - Therapeutic ratio

KW - Two-dimensional radiotherapy

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