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. 2014 Jan 21;110(2):297-303.
doi: 10.1038/bjc.2013.715. Epub 2013 Dec 12.

Prognostic model for survival of local recurrent nasopharyngeal carcinoma with intensity-modulated radiotherapy

Y-M Tian  1 , Y-H Tian  2 , L Zeng  1 , S Liu  1 , Y Guan  1 , T-X Lu  1 , F Han  1
Affiliations

Prognostic model for survival of local recurrent nasopharyngeal carcinoma with intensity-modulated radiotherapy

Y-M Tian et al. Br J Cancer. .

Abstract

Background: Intensity-modulated radiotherapy (IMRT) is the main salvage treatment for advanced locally recurrent nasopharyngeal carcinoma (NPC); however, survival outcomes vary. We aimed to construct a prognostic-score model to identify patients who could benefit from salvage IMRT.

Methods: This retrospective study involved 251 patients with locally recurrent NPC. The following parameters were analysed following IMRT: patient performance status, age, gender, late complications, T-stage of recurrence, synchronous nodal recurrence, primary gross tumour volume (GTV-nx), disease-free interval, re-irradiation dose and chemotherapy. The model was based on the hazard ratio coefficients of six significantly negative prognostic factors for survival.

Results: Significantly negative prognostic factors included Karnofsky Performance Status ≤70, age >50 years, late complications, recurrent T(3-4) stage, synchronous nodal recurrence and GTV-nx >30 cm(3). Three subgroups were defined according to model scores: low risk (0-4), intermediate risk (5-8) and high risk (9-15). The 5-year overall survival rates were 64.3%, 32.2% and 7.7%, respectively. The main cause of death was radiation-induced complications.

Conclusion: The prognostic-score model demonstrated that re-irradiation with IMRT is suitable for low-risk and intermediate-risk patients but may be unsuitable for high-risk patients. Further research into the protection of critical adjacent organs to reduce late complications in these patients is warranted.

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Figures

Figure 1
Figure 1
Representative MR images and treatment plan of one patients. Axial T1-weighted (A), contrast-enhanced T1-weighted (B), and coronal contrast-enhanced fat-saturated T1-weighted MR images (C) show a left-sided recurrent NPC with lateral extension to parapharygneal space and superior extension into the left intracranial cavity. (D–F) Delineation of target volume and dose-volume histogram (DVH) included temporal lobe (TL) and brainstem (BS).
Figure 2
Figure 2
Kaplan–Meier survival curves for OS according to KPS (A), age (B) and significant complications (C).
Figure 3
Figure 3
Kaplan–Meier survival curves for OS according to recurrent stage (A), presence of synchronous nodal recurrence (B), volume of GTV-nx (C) and the different risk groups (D).
Figure 4
Figure 4
A prognostic model was built based on six patient and disease factors. The total score can be calculated in predicting the median survival according to the prognostic factors.
See this image and copyright information in PMC

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