Cancer Res Treat.  2016 Apr;48(2):537-545. 10.4143/crt.2015.081.

Tumor Volume Reduction Rate during Adaptive Radiation Therapy as a Prognosticator for Nasopharyngeal Cancer

• Lee H
• Ahn YC
• Oh D
• Nam H
• Noh JM
• Park SY

• KMID: 2454330
• DOI: http://doi.org/10.4143/crt.2015.081

Abstract

PURPOSE
The purpose of this study is to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) for nasopharyngeal cancer (NPC).
MATERIALS AND METHODS
We reviewed the RT records of 159 NPC patients treated with definitive RT with or without concurrent chemotherapy between January 2006 and February 2013. Adaptive re-planning was performed in all patients at the third week of RT. The pre- and mid-RT gross tumor volumes (GTVs) of the primary tumor and the metastatic lymph nodes were measured and analyzed for prognostic implications.
RESULTS
After a median follow-up period of 41.5 months (range, 11.2 to 91.8 months) for survivors, there were 43 treatment failures. The overall survival and progression-free survival (PFS) rates at 5 years were 89.6% and 69.7%, respectively. The mean pre-RT GTV, mid-RT GTV, and TVRR were 45.9 cm3 (range, 1.5 to 185.3 cm3), 26.7 cm3 (1.0 to 113.8 cm3), and -41.9% (range, -87% to 78%), respectively. Patients without recurrence had higher TVRR than those with recurrence (44.3% in the no recurrence group vs. 34.0% in the recurrence group, p=0.004), and those with TVRR > 35% achieved a significantly higher rate of PFS at 5 years (79.2% in TVRR > 35% vs. 53.2% in TVRR ≤ 35%; p < 0.001). In multivariate analysis, TVRR was a significant factor affecting PFS (hazard ratio, 2.877; 95% confidence interval, 1.555 to 5.326; p=0.001).
CONCLUSION
TVRR proved to be a significant prognostic factor in NPC patients treated with definitive RT, and could be used as a potential indicator for early therapeutic modification during the RT course.

Keyword

Tumor volume reduction rate; Nasopharyngeal carcinoma; Radiotherapy; Adaptive therapy; Prognostic factor

MeSH Terms

Disease-Free Survival
Drug Therapy
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Nasopharyngeal Neoplasms*
Radiotherapy
Recurrence
Survivors
Treatment Failure
Tumor Burden*

Figure

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  Fig. 1. Scheme of adaptive re-plan for tumor volume measurements along the radiation therapy (RT) course. CT, computed tomography.

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  Fig. 2. Examples of gross tumor volume (GTV) delineation: GTVs of primary tumor (pGTV) and metastatic lymph node (nGTV) were delineated on computed tomography images taken before radiation therapy (A, C) and during radiation therapy (at 28.6 Gy irradiation) (B, D) in a patient with cT3N2M0 nasopharyngeal cancer. Tumor reduction rate in this case was –40%.

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  Fig. 3. (A) Univariate analyses of various cut-offs of tumor volume reduction rate (TVRR) in the context of predicting progression-free survival. (B) Kaplan-Meier curves of progression-free survival stratified using a 35% TVRR.

Reference

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