Clinical application of tumor volume in advanced nasopharyngeal carcinoma to predict outcome

Abstract

Background: Current staging systems have limited ability to adjust optimal therapy in advanced nasopharyngeal carcinoma (NPC). This study aimed to delineate the correlation between tumor volume, treatment outcome and chemotherapy cycles in advanced NPC.

Methods: A retrospective review of 110 patients with stage III-IV NPC was performed. All patients were treated first with neoadjuvant chemotherapy, then concurrent chemoradiation, and followed by adjuvant chemotherapy as being the definitive therapy. Gross tumor volume of primary tumor plus retropharyngeal nodes (GTVprn) was calculated to be an index of treatment outcome.

Results: GTVprn had a close relationship with survival and recurrence in advanced NPC. Large GTVprn (> or =13 ml) was associated with a significantly poorer local control, lower distant metastasis-free rate, and poorer survival. In patients with GTVprn > or =13 ml, overall survival was better after > or =4 cycles of chemotherapy than after less than 4 cycles.

Conclusions: The incorporation of GTVprn can provide more information to adjust treatment strategy.

Figure 1

Cumulative survival rates were stratified by primary tumor volume. The 3-year overall survival in subgroups with GTVprn <13 ml and ≧ 13 ml were 92% and 54%. Large GTVprn (≧ 13 ml) was associated with a significantly poorer survival (p < 0.05).

Figure 2

Analysis of the subgroup with GTVprn ≧ 13 ml revealed better overall survival after ≧ 4 cycles of chemotherapy than after less than 4 cycles. (p < 0.05).