This study aimed to evaluate the efficacy of concurrent chemoradiotherapy (CCRT) for stage II nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). A total of 249 patients were retrospectively reviewed. All patients were treated with IMRT. One hundred forty-three patients treated with CCRT and 106 patients treated with IMRT alone. With a median follow-up of 59.4 months, adding concurrent chemotherapy did not statistically significantly improve the 5-year overall survival (OS) (89.7 % vs 99.0 %, p = 0.278), locoregional relapse-free survival (LRFS) (94.8 % vs 89.3 %, p = 0.167), and distant metastases-free survival (DMFS) (93.4 % vs 97.5 %, p = 0.349). The patients with CCRT significantly experienced more acute toxic effects. The main grades 3-4 toxicity reactions were mucositis (26.6 % vs 15.1 %, p = 0.03) and leukopenia/neutropenia (9.1 % vs 0.9 %, p = 0.005). In subgroup analysis of patients with concurrent platinum single-agent chemotherapy the 5-year OS (98.4 % vs 81.9 %, p = 0.013) and DMFS (96.9 % vs 84.4 %, p = 0.043) of patients with platinum every 3 weeks (Q3W) were significantly higher than those with platinum weekly (QW) and no significant difference for LRFS (96.8 % vs 90.4 %, p = 0.150). CCRT did not improve the survival of patients with stage II NPC but increased the acute toxicity reactions. Patients with platinum Q3W improved the 5-year OS and DMFS, compared with those with platinum QW.

Long-term outcomes of concurrent chemoradiotherapy versus radiotherapy alone in stage II nasopharyngeal carcinoma treated with IMRT: a retrospective study.

Purpose To establish the regional lymph node (LN) distribution probability map and draw the neck clinical target volume specific to nasopharyngeal carcinoma (NPC). Methods and Materials One thousand patients with pathologically proven NPC were enrolled from January 2010 to December 2011. The center point of the LNs with a minimal axial diameter of ≥4 mm was marked on a single treatment planning computed tomography scan. The neck LN levels I to X using the 2013 updated international consensus guidelines were also contoured. LN distribution probability maps and distribution curves were established. The relationships between the LN distribution and consensus guidelines were analyzed to propose modifications for clinical target volume boundaries specific to NPC. Results A total of 10,651 LNs from 959 patients were marked. Based on the distribution of LNs and consensus guidelines, most of the LN levels defined in the 2013 updated consensus guidelines were confirmed to be comprehensive and applicable for NPC. However, for level Vb, 13.3% of cases (11 of 83) had LNs beyond the posteromedial border. For level VIIa (retropharyngeal LN), 1.5% of cases (12 of 819) had LNs above the cranial boundary, and 5 cases had LNs that emerged in the medial group. Moreover, we confirmed that no LN had been detected in certain areas of levels Ib, II, IVa, and Vc. Accordingly, a new level VIIc was proposed to include the medial group of retropharyngeal LNs, moderately extended boundaries for levels Vb and VIIa were recommended, and reduced boundaries are possibly adaptable for levels Ib, II, IV, and Vc. Conclusions Most LN levels in the 2013 updated consensus guidelines are comprehensive and applicable for NPC. We have proposed a new level VIIc to include a medial group of retropharyngeal LNs, recommended moderate extended boundaries for levels Vb and VIIa, and suggested that the boundaries for levels Ib, II, IV, and Vc might be reduced.

Delineation of Neck Clinical Target Volume Specific to Nasopharyngeal Carcinoma Based on Lymph Node Distribution and the International Consensus Guidelines.

Level Ib CTV delineation in nasopharyngeal carcinoma based on lymph node distribution and topographic anatomy.

Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care.

Contemporary management of the neck in nasopharyngeal carcinoma.

The deep learning (DL)-based prediction of accurate lymph node (LN) clinical target volumes (CTVs) for nasopharyngeal carcinoma (NPC) radiotherapy (RT) remains challenging. One of the main reasons is the variability of contours despite standardization processes by expert guidelines in combination with scarce data sharing in the community. Therefore, we retrospectively generated a 262-subjects dataset from four centers to develop the DL models for LN CTVs delineation. This dataset included 440 computed tomography images from different scanning phases, disease stages and treatment strategies. Three clinical expert boards, each comprising two experts (totalling six experts), manually delineated six basic LN CTVs on separate cohorts as the ground truth according to LN involvement and clinical requirements. Several state-of-the-art segmentation algorithms were evaluated on this benchmark, showing promising results for LN CTV segmentation. In conclusion, this work built a multicenter LN CTV segmentation dataset, which may be the first dataset for automatic LN CTV delineation development and evaluation, serving as a benchmark for future research. 

A multicenter dataset for lymph node clinical target volume delineation of nasopharyngeal carcinoma

Level IIb CTV delineation based on cervical fascia anatomy in nasopharyngeal cancer.

Objective To evaluate the long-term results and prognostic factors in 582 nasopharyngeal carcinoma ( NPC ) patients treated by intensity modulated radiotherapy ( IMRT ) . Methods 582 newly diagnosed NPC patients treated by IMRT in Sichuan cancer hospital from Jan. 2001 to Dec. 2004were reviewed. According to 2002UICC staging system, there were 36 stage Ⅰ , 144 stage Ⅱ , 224 stage Ⅲ, 178 stage Ⅳa. The Kaplan-Meier method was used to calculate the survival rate. Acute and late toxicities were graded according to the radiation therapy oncology group (RTOG) radiation morbidity scoring criteria. Results The follow up rate was 93.5％. The 5-year local control, regional control, distant metastasis-free survival, disease free survival, disease specific survival and overall survival rate was 89. 8％,95. 2％, 74. 1％, 69.6％, 83.2％ and 77. 1％. There were 29, 13 and 117 patients who had developed local, regional and distant recurrence respectively. The incidence of grade 3 acute ( salivary gland、 oral mucosa and skin) and late toxicity was 44. 5％ and 4. 2％. No grade 4 acute and late toxicity reaction was found. Multivariate analysis showed that clinical stage, N stage, radiotherapy interruption, age, HGB and weight loss were the independent prognostic factors for the overall survival. Conclusions NPC treated with IMRT could get good long-term survival with high quality of life. The clinical stage and N stage were the main prognostic factors for the overall survival. The acute and late toxicities were mainly grade 1 and 2.Distant metastasis is the main cause of treatment failure.

Key words: 
Nasopharyngeal neoplasms/radiotherapy ;  Radiotherapy, intensity-modulated; Prognosis

Long-term results and prognostic factors in 582 nasopharyngeal carcinoma treated by intensitymodulated radiotherapy

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Level IIb CTV delineation based on cervical fascia anatomy in nasopharyngeal cancer.

Long-term results and prognostic factors in 582 nasopharyngeal carcinoma treated by intensitymodulated radiotherapy