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. 2022 Sep 2:12:800400.
doi: 10.3389/fonc.2022.800400. eCollection 2022.

Is a high-risk clinical target volume required? Evaluation of the dosimetric feasibility based on T staging

Xingxing Yuan  1   2 , Chao Yan  1   2 , Shiyi Peng  1   2 , Zhiping Chen  1   2 , Tianzhu Lu  1   2 , Qiaoying Gong  1   2 , Yang Qiu  1   2 , Wenming Xiong  1   2 , Fenghua Ao  1   2 , Guoqing Li  1   2 , Jingao Li  1   2 , Ziwei Tu  1   2
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Is a high-risk clinical target volume required? Evaluation of the dosimetric feasibility based on T staging

Xingxing Yuan et al. Front Oncol. .

Abstract

Background: Clinical target delineation is a primary focus in the field of radiotherapy. This study aimed to investigate whether high-risk clinical target volume can be removed in nasopharyngeal carcinoma patients with different T stages.

Materials and methods: We designed a test plan without the high-risk clinical target volume for 111 nasopharyngeal carcinoma patients and further compared the test plans with the treatment plans in the parameters of planning target volumes and the radiation dose to normal organs.

Results: Our data showed that when high-risk clinical target volume was abnegated, target coverage, conformity indices, and homogeneity indices of planning target volumes and doses of normal organs were not influenced in the T4 nasopharyngeal carcinoma patients, and more than 95% of the high-risk planning target volume area could still be covered by the 60 Gy dose line. However, only some T1-3 patients achieved the ideal dose coverage, and even fewer after induction chemotherapy (62.8% vs. 41.2%, p = 0.018). Gross tumor volume was positively correlated with the target coverage of the original high-risk planning target volume in the test-plan (p = 0.0001). Gross tumor volume can be used to predict whether the target coverage of high-risk planning target volume is more than 95% (area under the curve = 0.868).

Conclusion: Omitting high risk clinical target volume can be considered in patients with T4 nasopharyngeal carcinoma according to physical evaluations. However, this approach is only suitable for a specific subset of T1-3 patients.

Keywords: IMRT; T staging; nasopharyngeal carcinoma; omitting CTVp1; plan evaluation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The treatment target area and dose distribution of a T4 nasopharyngeal carcinoma patient. Left: The treatment target area diagram; Middle: The dose distribution diagram of treat-plan; Right: The dose distribution diagram of test-plan.
Figure 2
Figure 2
The target coverage of PTV1 in T4 and T1–3patients nasopharyngeal carcinoma patients received induction chemotherapy or not.
Figure 3
Figure 3
Correlation analysis chart between GTVnx volume and the target coverage of PTV1.
Figure 4
Figure 4
Receiver operating characteristic (ROC) curves for the predictive value of using GTVnx volume to discriminate whether the prescribed dose (60 Gy) cover at least 95% of the volume of PTV1.
See this image and copyright information in PMC

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