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Prognostic Impact of Primary Tumor Volume in Patients With Nasopharyngeal Carcinoma Treated by Definitive Radiation Therapy
Author(s) -
Shen Chunying,
Lu Jiade Jay,
Gu Yajia,
Zhu Guopei,
Hu Chaosu,
He Shaoqin
Publication year - 2008
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/mlg.0b013e31816ed587
Subject(s) - medicine , nasopharyngeal carcinoma , radiation therapy , primary tumor , nuclear medicine , hazard ratio , carcinoma , stage (stratigraphy) , cancer , nasopharyngeal cancer , confidence interval , metastasis , paleontology , biology
Objectives/Hypothesis: Tumor burden has been confirmed as one of the important indicators in disease control after treatment for various types of malignancies. This report aims to document the value of the primary tumor volume of nasopharyngeal carcinoma [gross tumor volume of the primary site (GTV‐P)] in predicting the treatment outcome after high‐dose definitive radiation therapy. Study Design: A total of 154 patients with nasopharyngeal carcinoma were prospectively treated with accelerated hyperfractionated radiotherapy alone to a total dose of 78 Gy/60 fractions/6 weeks (biological effective dose = 88.2 Gy). Methods: Patients were assessed for local control, disease‐free survival and distant failure free survival. The GTV‐P was calculated by summation of area technique after delineation of the primary tumor contours on computed tomography images. Results: The median GTV‐P was 14.5 mL for T1, 23.3 mL for T2, 35.8 mL for T3, and 50.9 mL for T4 diseases ( P < .05). With a median follow‐up of 61 months, the 5‐year local failure‐free rate, disease‐free survival and distant failure‐free survival rates were 89.4% versus 48.9% ( P = .002), 56.6% versus 0% ( P = .001), and 66.9% versus 16.5% ( P = .0001), respectively, for patients whose GTV‐P were ≤60 mL and >60 mL. Multivariate analysis revealed that GTV‐P is an independent prognostic factorfor local control (hazard ratio = 3.568, P = .035). There fore, the GTV‐P was significantly associated with the treatment outcome after high‐dose radiation delivered in accelerated hyperfractionated schedule for nasopharyngeal cancer patients. Conclusions: Tumor volume is a reliable indicator for supplementing the T classification of the Tumor, Node, Metastasis staging system for predicting local control after definite radiation therapy.