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

被引:31
作者
Chua, DTT
Sham, JST
Leung, LHT
Tai, KS
Au, GKH
机构
[1] Univ Hong Kong, Queen Mary Hosp, Dept Clin Oncol, Hong Kong, Hong Kong, Peoples R China
[2] Univ Hong Kong, Queen Mary Hosp, Dept Diagnost Radiol, Hong Kong, Hong Kong, Peoples R China
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2004年 / 58卷 / 05期
关键词
tumor volume; nasopharyngeal carcinoma; early stage;
D O I
10.1016/j.ijrobp.2003.09.075
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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 cm(3) (median, 12.6 cm(3)), with substantial overlap between T1 and T2 disease. The NV ranged from 0 to 35.4 cm(3). Patients with a PTV >15 cm(3) 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 cm(3) 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 :54 cm(3) and a NV of >4 cm(3) (5-year control rate, 97 % vs. 100 %). The survival rate was worst in patients with a PTV >15 cm(3) and a NV >4 cm(3) (5-year DSS rate, 68%) and best in those with a PTV of less than or equal to15 cm(3) and a NV of less than or equal to4 cm(3) (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. (C) 2004 Elsevier Inc.
引用
收藏
页码:1437 / 1444
页数:8
相关论文
共 23 条
[1]   Observer error in the assessment of nodal disease in head and neck cancer [J].
Alderson, DJ ;
Jones, TM ;
White, SJ ;
Roland, NJ .
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, 2001, 23 (09) :739-743
[2]  
[Anonymous], 1997, MAN STAG CANC
[3]   DOSE, VOLUME, AND TUMOR-CONTROL PREDICTIONS IN RADIOTHERAPY [J].
BRENNER, DJ .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1993, 26 (01) :171-179
[4]   The effect of primary tumor volumes in advanced T-staged nasopharyngeal tumors [J].
Chang, CC ;
Chen, MK ;
Liu, MT ;
Wu, HK .
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, 2002, 24 (10) :940-946
[5]   Concomitant radiotherapy and chemotherapy for early-stage nasopharyngeal carcinoma [J].
Cheng, SH ;
Tsai, SYC ;
Yen, KL ;
Jian, JJM ;
Chu, NM ;
Chan, KY ;
Tan, TD ;
Cheng, JC ;
Hsieh, CY ;
Huang, AT .
JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (10) :2040-2045
[6]  
Chua DTT, 1996, CANCER, V78, P202, DOI 10.1002/(SICI)1097-0142(19960715)78:2<202::AID-CNCR3>3.0.CO
[7]  
2-N
[8]   Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome [J].
Chua, DTT ;
Sham, JST ;
Kwong, DLW ;
Tai, KS ;
Wu, PM ;
Lo, M ;
Yung, A ;
Choy, D ;
Leong, L .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1997, 39 (03) :711-719
[9]   IRRADIATION ALONE FOR SUPRAGLOTTIC LARYNX-CARCINOMA - CAN CT FINDINGS PREDICT TREATMENT RESULTS [J].
FREEMAN, DE ;
MANCUSO, AA ;
PARSONS, JT ;
MENDENHALL, WM ;
MILLION, RR .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1990, 19 (02) :485-490
[10]   Value of computed tomography as outcome predictor of supraglottic squamous cell carcinoma treated by definitive radiation therapy [J].
Hermans, R ;
Van den Bogaert, W ;
Rijnders, A ;
Baert, AL .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1999, 44 (04) :755-765