Recurrent Patterns in Patients With Nasopharyngeal Caricinoma and Risks Leading to Inaccurate Delineation in Marginal Failure in the Era of Intensity-Modulated Radiotherapy

Shu Zhang; Ni Zeng; Jiangping Yang; Jiaqi Han; Jinlan He; Baofeng Duan; Xiaoqiang Chen; Xiaofang Gou; Fubin Zhu; Huizhen Liu; Ming Zeng; Di Yan; Nianyong Chen

doi:10.1002/hed.27987

Recurrent Patterns in Patients With Nasopharyngeal Caricinoma and Risks Leading to Inaccurate Delineation in Marginal Failure in the Era of Intensity-Modulated Radiotherapy

Head Neck. 2025 Mar;47(3):917-927. doi: 10.1002/hed.27987. Epub 2024 Nov 5.

Authors

Shu Zhang^{1

2}, Ni Zeng¹, Jiangping Yang¹, Jiaqi Han¹, Jinlan He^{1

2}, Baofeng Duan^{1

2}, Xiaoqiang Chen³, Xiaofang Gou³, Fubin Zhu⁴, Huizhen Liu⁵, Ming Zeng⁶, Di Yan^{7

8}, Nianyong Chen^{1

2}

Affiliations

¹ Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
² Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
³ Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
⁴ Department of Cancer, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China.
⁵ Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China.
⁶ Department of Experimental Research, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
⁷ Adaptive Radiotherapy Research Laboratory, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
⁸ Oakland University/Beaumont School of Medicine, Rochester, Michigan, USA.

PMID: 39501710
DOI: 10.1002/hed.27987

Abstract

Objective: To investigate the failure patterns of recurrent nasopharyngeal carcinoma (NPC), especially to identify the relationship between the recurrent-prone anatomic structures and the tumor regression sites after the introduction of chemotherapy (IC).

Method: A cohort of 1121 non-metastatic patients with NPC was retrospectively enrolled. The pretreatment and recurrent images of each patient were registered to the planning CT. Tumor regression sites after IC (Vicr) overlapped with recurrent tumor (rGTV) were evaluated for the delineation accuracy and dose sufficiency in marginal failure patients.

Results: A total of 126 (11.24%) experienced tumor recurrence. Re-evaluation of 12 patients with local marginal recurrence, their rGTV within Vicr predominantly located at choanae, sphenoidal sinus, and cavernous sinus. The regression sites did not receive the full 70 Gy but over half receiving with 60Gy.

Conclusion: Analysis from marginal failure that exempts tumor regression sites from GTV or an insufficient prescription dose of less than 70 Gy may contribute to marginal failure.

Keywords: dosimetry; intensity‐modulated radiotherapy; marginal failure; nasopharyngeal carcinoma; pattern of local failure.

MeSH terms

Adult
Aged
Carcinoma
Cohort Studies
Female
Humans
Male
Middle Aged
Nasopharyngeal Carcinoma
Nasopharyngeal Neoplasms* / diagnostic imaging
Nasopharyngeal Neoplasms* / mortality
Nasopharyngeal Neoplasms* / pathology
Nasopharyngeal Neoplasms* / radiotherapy
Nasopharyngeal Neoplasms* / therapy
Neoplasm Recurrence, Local* / diagnostic imaging
Neoplasm Recurrence, Local* / pathology
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated* / methods
Retrospective Studies
Risk Assessment
Tomography, X-Ray Computed
Treatment Failure
Young Adult

Abstract

MeSH terms

Grants and funding