PMID- 32971188
OWN - NLM
STAT- MEDLINE
DCOM- 20210701
LR  - 20210701
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 109
IP  - 2
DP  - 2021 Feb 1
TI  - Simultaneous Reduction of Volume and Dose in Clinical Target Volume for 
      Nasopharyngeal Cancer Patients.
PG  - 495-504
LID - S0360-3016(20)34306-6 [pii]
LID - 10.1016/j.ijrobp.2020.09.034 [doi]
AB  - PURPOSE: To compare the treatment outcome and severe late adverse effects (AEs) 
      between conventional volume and dose (CVD) and simultaneously reduced volume and 
      dose (SRVD) of clinical target volume treatments in patients with nasopharyngeal 
      carcinoma. METHODS AND MATERIALS: This retrospective cohort study enrolled 
      patients with nonmetastatic stage II to IV nasopharyngeal cancer from a single 
      institute. Survival endpoints and severe (>/=grade 3) late AEs and comorbidity were 
      compared between groups. The correlation of severe late AEs, comorbidity, and 
      overall survival (OS) were evaluated using Kaplan-Meier and Cox regression 
      methods. RESULTS: From January 2012 to June 2017, this study enrolled 178 
      patients, 64 in the CVD group and 114 in the SRVD group. The 2 groups did not 
      differ significantly in patient characteristics except for mean follow-up time 
      (37.6 vs 48.8 months; P = .01). The SRVD group did not significantly differ from 
      the CVD group in local control survival (82.0% vs 78.4%; P = .85), regional 
      control survival (89.9% vs 86.0%; P = .62), or disease-free survival (76.4% vs 
      66.9%; P = .67). The SRVD group had significantly better OS (93.9% vs 67.0%; P < 
      .001) and salvage survival (79.3% vs 20.7%; P < .01) and a significantly lower 
      ratio of severe lung infection (1 of 113 vs 5 of 59; P = .02). The SRVD group had 
      a significantly lower risk of mortality (hazard ratio [HR], 0.3; P = .03). The 
      factors associated with a significantly higher risk of mortality were N3 
      (regional lymph node stage status of N3) (HR, 3.0; P = .02); comorbidities of 
      diabetes, coronary artery disease, or chronic kidney disease (grades 2-3) (HR, 
      3.8; P = .009), and severe lung infection (HR, 6.3; P = .007). CONCLUSIONS: 
      Simultaneously reduced volume and dose of clinical target volumes did not impair 
      locoregional control or disease-free survival. The benefits of SRVD treatment may 
      include significant reduction in severe late AEs, particularly lung infection, 
      dysphagia, and xerostomia. However, additional studies with longer patient 
      follow-up are required to confirm these benefits.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Liu, Wen-Shan
AU  - Liu WS
AD  - Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, 
      Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan; School of 
      Medicine, National Defense Medical Center, Taipei, Taiwan. Electronic address: 
      wsliu@vghks.gov.tw.
FAU - Tsai, Kuo-Wang
AU  - Tsai KW
AD  - Department of Medical Education and Research, Kaohsiung Veterans General 
      Hospital, Kaohsiung, Taiwan; Department of Research, Taipei Tzu Chi Hospital, The 
      Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
FAU - Kang, Bor-Hwang
AU  - Kang BH
AD  - School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department 
      of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General 
      Hospital, Kaohsiung, Taiwan.
FAU - Yang, Ching-Chieh
AU  - Yang CC
AD  - Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan; 
      Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, 
      Taiwan.
FAU - Huang, Wei-Lun
AU  - Huang WL
AD  - Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, 
      Taiwan.
FAU - Lee, Ching-Chih
AU  - Lee CC
AD  - School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department 
      of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General 
      Hospital, Kaohsiung, Taiwan.
FAU - Hu, Yu-Chang
AU  - Hu YC
AD  - Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, 
      Taiwan.
FAU - Chang, Kuo-Ping
AU  - Chang KP
AD  - Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans 
      General Hospital, Kaohsiung, Taiwan.
FAU - Chen, Hsiu-Min
AU  - Chen HM
AD  - Department of Research Center of Medical Informatics, Kaohsiung Veterans General 
      Hospital, Kaohsiung, Taiwan.
FAU - Lin, Yaoh-Shiang
AU  - Lin YS
AD  - School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department 
      of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General 
      Hospital, Kaohsiung, Taiwan.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200921
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adult
MH  - Aged
MH  - Disease-Free Survival
MH  - Dose-Response Relationship, Radiation
MH  - Endpoint Determination
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nasopharyngeal Neoplasms/complications/*radiotherapy
MH  - Retrospective Studies
EDAT- 2020/09/25 06:00
MHDA- 2021/07/02 06:00
CRDT- 2020/09/24 20:09
PHST- 2020/03/22 00:00 [received]
PHST- 2020/09/10 00:00 [revised]
PHST- 2020/09/16 00:00 [accepted]
PHST- 2020/09/25 06:00 [pubmed]
PHST- 2021/07/02 06:00 [medline]
PHST- 2020/09/24 20:09 [entrez]
AID - S0360-3016(20)34306-6 [pii]
AID - 10.1016/j.ijrobp.2020.09.034 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2021 Feb 1;109(2):495-504. doi: 
      10.1016/j.ijrobp.2020.09.034. Epub 2020 Sep 21.