J Cancer 2020; 11(7):1968-1975. doi:10.7150/jca.39588 This issue

Research Paper

Analysis of Clinical Target Volume Delineation in Local-regional Failure of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy

Xiaojing Yang1*, Hanru Ren2*, Weiwei Yu1, Xiulong Zhang1, Yi Sun1, Yuhui Shao1, Lihua Zhang1, Hongling Li1, Xinmiao Yang1, Jie Fu1✉

1. Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China.
2. Department of Orthopedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai 201300, P.R China
* These authors made equal contributions.

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Yang X, Ren H, Yu W, Zhang X, Sun Y, Shao Y, Zhang L, Li H, Yang X, Fu J. Analysis of Clinical Target Volume Delineation in Local-regional Failure of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy. J Cancer 2020; 11(7):1968-1975. doi:10.7150/jca.39588. Available from https://www.jcancer.org/v11p1968.htm

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OBJECTIVE: To analyze the pattern of local failure in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT) and find a more reasonable delineation of the clinical target volume (CTV).

METHODS AND MATERIALS: A total of 212 patients with non-metastatic NPC who underwent IMRT were analyzed. Radiation therapy was run at a total dose of 66-74 Gy (2.0-2.2 Gy fractions). The follow-up of local recurrence and the recurrence-related features were analyzed for the original treatment situation. The failures were delimited as “in-field failure” if Vrecur within the 95% isodose curve (V95%) was ≥95%; “marginal failure” if V95% was less than 95% and not less than 20%; or “out-field failure” if V95% was< 20%. Kaplan-Meier method was used to calculate the survival rates.

RESULTS: The median follow-up was 43.4 months. The 5-year local relapse-free survival and overall survival rates were 85.6 and 77.8%, respectively. A total of 18 patients have relapsed. The in-field failure, marginal failure, and out-field failure accounted for 83.3%, 11.1%, and 5.6%, respectively. The site of recurrence was basically in the high dose area.

CONCLUSION: These findings suggested that IMRT provide a good local control for patients with NPC, and the in-field failure is the main mode. A wide range of CTV cannot prevent the local recurrence, narrowing the CTV to protect the adjacent organs should be taken into consideration.

Keywords: Clinical target volume, Delineation, Nasopharyngeal carcinoma, Intensity-modulated radiotherapy