Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: the University of California-San Francisco experience.

摘要: Abstract Purpose: To review our experience with three-dimensional intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: We reviewed records 35 patients who underwent 3D IMRT for carcinoma at University California–San Francisco between April 1995 March 1998. According to 1997 American Joint Committee on Cancer staging classification, 4 (12%) had Stage I disease, 6 (17%) II, 11 (32%) III, 14 (40%) IV disease. primary tumor was delivered using one following three techniques: ( 1 ) manually cut partial transmission blocks, 2 computer-controlled autosequencing static multileaf collimator (MLC), 3 Peacock system a dynamic multivane intensity-modulating (MIMiC). A forward treatment-planning used first two methods, an inverse planning third method. The neck irradiated conventional technique lateral opposed fields upper anterior field lower supraclavicular fossae. prescribed dose 65–70 Gy gross volume (GTV) positive nodes, 60 clinical target (CTV), 50–60 clinically negative neck. Eleven fractionated high-dose-rate intracavitary brachytherapy boost 1–2 weeks external beam radiotherapy. Thirty-two (91%) also received cisplatin during, 5-fluorouracil after, Acute late normal tissue effects were graded according Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Local-regional progression-free, distant metastasis-free survival overall estimated Kaplan–Meier Results: With median follow-up 21.8 months (range, 5–49 months), local-regional progression-free rate 100%. 4-year 94%, 57%. worst acute toxicity Grade 16 (46%) patients, 18 (51%) (3%) patient. 15 (43%), 13 (37%), 5 (14%) patients. Only patient transient soft-tissue necrosis. At 24 after treatment, 50% evaluated 0, 1, none xerostomia. Analysis dose–volume histograms (DVHs) showed that average maximum, mean, minimum 79.5 Gy, 75.8 56.5 GTV, 78.9 71.2 45.4 CTV, respectively. An only 3% GTV 2% CTV less than 95% dose. 5% brain stem, optic chiasm, right left nerves 48.3 23.9 15.0 14.9 cc cervical spinal cord 41.7 Gy. doses within tolerance these critical structures. parotids, pituitary, T-M joints, ears 43.2 41.0 46.3 60.5 58.3 52.0 52.2 Conclusion: provided improved coverage increased significant sparing salivary glands other control combined chemotherapy excellent, although metastasis remained unabated.