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A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis

BACKGROUND: Radiation therapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) but also causes transient as well as long-term complications. Patients who develop severe radiation-induced brainstem injuries have a poor prognosis due to the lack of effective medical therapies. Howe...

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Autores principales: Yao, Cheng-Yun, Zhou, Guo-Ren, Wang, Li-Jun, Xu, Jian-Hua, Ye, Jin-jun, Zhang, Lan-Fang, He, Xia, Chen, Zhen-Zhang, Huang, Sheng-Fu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171220/
https://www.ncbi.nlm.nih.gov/pubmed/30285884
http://dx.doi.org/10.1186/s13014-018-1105-z
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author Yao, Cheng-Yun
Zhou, Guo-Ren
Wang, Li-Jun
Xu, Jian-Hua
Ye, Jin-jun
Zhang, Lan-Fang
He, Xia
Chen, Zhen-Zhang
Huang, Sheng-Fu
author_facet Yao, Cheng-Yun
Zhou, Guo-Ren
Wang, Li-Jun
Xu, Jian-Hua
Ye, Jin-jun
Zhang, Lan-Fang
He, Xia
Chen, Zhen-Zhang
Huang, Sheng-Fu
author_sort Yao, Cheng-Yun
collection PubMed
description BACKGROUND: Radiation therapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) but also causes transient as well as long-term complications. Patients who develop severe radiation-induced brainstem injuries have a poor prognosis due to the lack of effective medical therapies. However, the relationship between brainstem injury and radiation volume dose is unknown. In this study, we found that radiation-induced brainstem injury was significantly associated with brainstem dose per unit volume. METHODS: A retrospective analysis was performed on a consecutive cohort of 327 patients with NPC receiving IMRT from May 2005 to December 2014. Dose-volume data and long-term outcome were analyzed. RESULTS: The median follow-up duration was 56 months (range, 3–141 months), and six with T(4) and two with T(3) patients had radiation-induced brainstem injuries. The 3-year and 5-year incidences were 2.2% and 2.8%, respectively. The latency period of brainstem injury ranged from 9 to 58 months, with a median period of 21 months. The Cox regression analysis showed that brainstem radiation toxicity was associated with the T(4) stage, D(2%) of gross tumor volume of nasopharyngeal primary lesions and their direct extensions (GTVnx), D(max) (the maximum point dose), D(1%), D(0.1cc) (the top dose delivered to a 0.1-ml volume), and D(1cc) (the top dose delivered to a 1-ml volume) of the brainstem (p < 0.05). Receiver operating characteristic (ROC) curves showed that GTVnx D(2%) and the D(max), D(1%), D(0.1cc), and D(1cc) of the brainstem were significant predictors of brainstem injury. The area under the ROC curve for these five parameters was 0.724, 0.813, 0.818, 0.818, and 0.798, respectively (p < 0.001), and the cutoff points 77.26 Gy, 67.85 Gy, 60.13 Gy, 60.75 Gy, and 54.58 Gy, respectively, were deemed as the radiation dose limit. CONCLUSIONS: Radiotherapy-induced brainstem injury was uncommon in patients with NPC who received definitive IMRT. Multiple dose-volume data may be the dose tolerance of radiation-induced brainstem injury.
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spelling pubmed-61712202018-10-10 A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis Yao, Cheng-Yun Zhou, Guo-Ren Wang, Li-Jun Xu, Jian-Hua Ye, Jin-jun Zhang, Lan-Fang He, Xia Chen, Zhen-Zhang Huang, Sheng-Fu Radiat Oncol Research BACKGROUND: Radiation therapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) but also causes transient as well as long-term complications. Patients who develop severe radiation-induced brainstem injuries have a poor prognosis due to the lack of effective medical therapies. However, the relationship between brainstem injury and radiation volume dose is unknown. In this study, we found that radiation-induced brainstem injury was significantly associated with brainstem dose per unit volume. METHODS: A retrospective analysis was performed on a consecutive cohort of 327 patients with NPC receiving IMRT from May 2005 to December 2014. Dose-volume data and long-term outcome were analyzed. RESULTS: The median follow-up duration was 56 months (range, 3–141 months), and six with T(4) and two with T(3) patients had radiation-induced brainstem injuries. The 3-year and 5-year incidences were 2.2% and 2.8%, respectively. The latency period of brainstem injury ranged from 9 to 58 months, with a median period of 21 months. The Cox regression analysis showed that brainstem radiation toxicity was associated with the T(4) stage, D(2%) of gross tumor volume of nasopharyngeal primary lesions and their direct extensions (GTVnx), D(max) (the maximum point dose), D(1%), D(0.1cc) (the top dose delivered to a 0.1-ml volume), and D(1cc) (the top dose delivered to a 1-ml volume) of the brainstem (p < 0.05). Receiver operating characteristic (ROC) curves showed that GTVnx D(2%) and the D(max), D(1%), D(0.1cc), and D(1cc) of the brainstem were significant predictors of brainstem injury. The area under the ROC curve for these five parameters was 0.724, 0.813, 0.818, 0.818, and 0.798, respectively (p < 0.001), and the cutoff points 77.26 Gy, 67.85 Gy, 60.13 Gy, 60.75 Gy, and 54.58 Gy, respectively, were deemed as the radiation dose limit. CONCLUSIONS: Radiotherapy-induced brainstem injury was uncommon in patients with NPC who received definitive IMRT. Multiple dose-volume data may be the dose tolerance of radiation-induced brainstem injury. BioMed Central 2018-10-03 /pmc/articles/PMC6171220/ /pubmed/30285884 http://dx.doi.org/10.1186/s13014-018-1105-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Yao, Cheng-Yun
Zhou, Guo-Ren
Wang, Li-Jun
Xu, Jian-Hua
Ye, Jin-jun
Zhang, Lan-Fang
He, Xia
Chen, Zhen-Zhang
Huang, Sheng-Fu
A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis
title A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis
title_full A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis
title_fullStr A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis
title_full_unstemmed A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis
title_short A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis
title_sort retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171220/
https://www.ncbi.nlm.nih.gov/pubmed/30285884
http://dx.doi.org/10.1186/s13014-018-1105-z
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