OBJECTIVE: To compare the side effects of intensity modulated radiotherapy(IMRT) and conventional radiotherapy in nasopharyngeal carcinoma. METHOD: Sixty nine cases of nasopharyngeal carcinoma were random selected by stages,with 32 cases in IMRT group and 37 cases in conventional radiotherapy group. The target areas in IMRT group were nasopharyngeal carcinoma, parapharyngeal space and neck lymphatic area with the fractional dose of 2.00-2.12 Gy per time, for 33-35 times. The cases in conventional radiotherapy group were given facio-cervical field radiation, DT 40-60 Gy per time, for 20-30 times. The reinforcing dosage in lateral facial field increased to DT 70 Gy in the nasopharyngeal area. The prophylactic irradiation dose of the neck was DT 50-55 Gy. RESULT: The incidence of dry mouth one year after radiotherapy in the IMRT and conventional radiotherapy groups were 9.38% (3/32) and 94.59% (35/37) respectively, with a significant difference between the two groups (P < 0.01). The incidence of difficulty in opening mouth in the IMRT and conventional radiotherapy groups were 6.25% (2/32) and 72.97% (27/37) respectively, with a significant difference between the two groups(P < 0.01). CONCLUSION Compared with the conventional radiotherapy, IMRT may improve the control rate and obviously de creases the side effects. It could be recommended for the radiotherapy of nasopharyngeal carcinoma.
Adult ; Carcinoma ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiotherapy ; adverse effects ; methods ; Radiotherapy, Intensity-Modulated ; adverse effects

OBJECTIVETo compare the radiation injuries of the temporomandibular joint (TMJ) following three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).

METHODSThirty-nine NPC patients without previous radiotherapy underwent 3D-CRT and another 32 received IMRT in our institute. The distance between the 2 dens incisivus medialis (DDIM) and LENT SOMA criteria were employed to evaluate TMJ injuries, clinical outcomes, and the performance-to-price ratios.

RESULTSThe short-term local response rates were similar between the two groups (P=0.878). The mean radiation doses of the TMJ were significantly higher in 3D-CRT group than in IMRT group (57.06 vs 40.90 Gy, P<0.001). The DDIM showed significant changes in 3D-CRT groups after the radiotherapy (P<0.05). No significant difference was found in the TMJ injuries between the two groups according to the SOMA criteria (P>0.05).

CONCLUSIONRadiation injuries of the TMJ are tolerable in both 3D-CRT and IMRT groups, and 3D-CRT is a more economic choice for patients who can not afford IMRT.

Carcinoma ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiation Injuries ; etiology ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; adverse effects ; methods ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Temporomandibular Joint ; injuries

PURPOSE: The validity of tomotherapy-based simultaneous integrated boost (TOMOSIB) was assessed in terms of acute intestinal/urinary toxicity by comparing with 3-dimensional conformal radiotherapy (3DCRT) in cases of whole-pelvis radiation therapy (WPRT) for prostate cancer. MATERIALS AND METHODS: Thirty-eight consecutive patients who underwent curative WPRT were retrospectively reviewed. Twenty six (68.4%) received 3DCRT and the others (31.6%) were treated with TOMOSIB. A local boost to the prostate circumferential area was added to WPRT sequentially for 3DCRT and concomitantly for TOMOSIB. The total median prostate or prostatic bed dose was 64.8 Gy including median 45.0 Gy of WPRT. Acute toxicities were assessed according to RTOG criteria. RESULTS: Overall intestinal toxicity was lower in TOMOSIB group than 3DCRT group (p=0.008). When it was divided into rectum and non-rectum intestine (NRI), TOMOSIB showed borderline superiority only in NRI toxicity (p=0.047). For the urinary toxicity, there was no significant difference between two groups (p=0.796). On dosimetric analysis for the rectum and bladder, dose delivered to 80% (p<0.001) and volume receiving 25-40 Gy (p<0.001) were remarkably higher in 3DCRT. For the NRI, only maximum dose showed significant results between two groups (p<0.001). CONCLUSION: Intestinal toxicity should be verified with more detailed anatomic categorization such as rectum and NRI. TOMOSIB could not reduce urinary toxicity because of inevitably high dose exposure to the prostatic urethra. Current dosimetry system did not properly reflect intestinal/urinary toxicity, and suitable dosimetric guidelines are needed in TOMOSIB.
Adenocarcinoma/pathology/*radiotherapy ; Aged ; Humans ; Intestine, Small/*radiation effects ; Male ; Middle Aged ; Pelvis/*radiation effects ; Prostatic Neoplasms/pathology/*radiotherapy ; Radiation Injuries ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated/*adverse effects/methods ; Rectum/radiation effects ; Retrospective Studies ; Urinary Bladder/*radiation effects

PURPOSE: The validity of tomotherapy-based simultaneous integrated boost (TOMOSIB) was assessed in terms of acute intestinal/urinary toxicity by comparing with 3-dimensional conformal radiotherapy (3DCRT) in cases of whole-pelvis radiation therapy (WPRT) for prostate cancer. MATERIALS AND METHODS: Thirty-eight consecutive patients who underwent curative WPRT were retrospectively reviewed. Twenty six (68.4%) received 3DCRT and the others (31.6%) were treated with TOMOSIB. A local boost to the prostate circumferential area was added to WPRT sequentially for 3DCRT and concomitantly for TOMOSIB. The total median prostate or prostatic bed dose was 64.8 Gy including median 45.0 Gy of WPRT. Acute toxicities were assessed according to RTOG criteria. RESULTS: Overall intestinal toxicity was lower in TOMOSIB group than 3DCRT group (p=0.008). When it was divided into rectum and non-rectum intestine (NRI), TOMOSIB showed borderline superiority only in NRI toxicity (p=0.047). For the urinary toxicity, there was no significant difference between two groups (p=0.796). On dosimetric analysis for the rectum and bladder, dose delivered to 80% (p<0.001) and volume receiving 25-40 Gy (p<0.001) were remarkably higher in 3DCRT. For the NRI, only maximum dose showed significant results between two groups (p<0.001). CONCLUSION: Intestinal toxicity should be verified with more detailed anatomic categorization such as rectum and NRI. TOMOSIB could not reduce urinary toxicity because of inevitably high dose exposure to the prostatic urethra. Current dosimetry system did not properly reflect intestinal/urinary toxicity, and suitable dosimetric guidelines are needed in TOMOSIB.
Adenocarcinoma/pathology/*radiotherapy ; Aged ; Humans ; Intestine, Small/*radiation effects ; Male ; Middle Aged ; Pelvis/*radiation effects ; Prostatic Neoplasms/pathology/*radiotherapy ; Radiation Injuries ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated/*adverse effects/methods ; Rectum/radiation effects ; Retrospective Studies ; Urinary Bladder/*radiation effects

OBJECTIVE: To observe the effect of adaptive replanning on adverse reactions and clinical outcome of nasopharyngeal carcinoma treated by helical tomotherapy. METHODS: Fifty nasopharyngeal carcinoma patients treated by TomoTherapy system were retrospectively analyzed. Among these patients, 25 received repetitive CT simulation and replanning, and another 25 case-matched control patients without replanning were identified by matching age, gender, pathological type, UICC stage, weight loss, etc. Wilcoxon test was used to evaluate the effect of replanning on acute and chronic radiation reactions within individuals. Kaplan-Meier study was used to estimate the survival of patients with or without replanning. RESULTS: There was a significant difference in late salivary grand damage between the replanning and the control group (P=0.046), while no difference was observed in acute or other late side effects between the two groups. The median follow-up of the two groups was 32 months (7-42 months) and 26 months (8-46 months), respectively. The median local relapse-free survival time, 2-year local relapse-free survival and 2-year lymphnode relapse-free survival in the two groups were similar (36 months, 92% and 100%). No significant difference was found in the 2-year metastasis relapsefree survival (80% and 96%) and the 2-year overall survival between the two groups (88% and 92%, P>0.05). CONCLUSION Adaptive replanning may reduce the severity of late damage of salivary glands after helical tomotherapy in nasopharyngeal carcinoma patients without improvement of 2-year survival rate.
Adult ; Carcinoma ; Carcinoma, Squamous Cell ; radiotherapy ; Female ; Humans ; Male ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; adverse effects ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo explore the clinical value and efficacy of reduced field intensity modulated radiation therapy (RF-IMRT) for patients with advanced cervical cancer.

METHODSSeventy-one patients with stage IIB-IIIB cervical cancer, who underwent reduced field IMRT (RF-IMRT group) and 72 patients treated with conventional radiotherapy (c-RT group) in Shandong Cancer Hospital between 2005 August and 2011 August, were enrolled in this study. The RF-IMRT plans were as follows: whole pelvic IMRT plan was performed to deliver an initial dose of 30 Gy, then the irradiated volume was reduced to lymphatic drainage region as well as paracervix and parametrium for an additional 30 Gy boost. Conventional 2-field RT plan was performed in these patients using ADAC Pinnacle 3 planning system, to be given the same prescription dose, and to compare the irradiation dose of organs at risk (OARs). At the same time, conventional 2-field RT was performed in 72 patients of the c-RT group. Concurrent chemotherapy and intracavitary brachytherapy were also performed in the two groups. The treatment response, toxicities, normal tissue avoidance, and survival were assessed.

RESULTSSixty-six patients of the RF-IMRT group and 65 patients of the c-RT group fulfilled the treatment plan. IMRT plans yielded better dose conformity to the target (0.711 ± 0.057 vs. 0.525 ± 0.062, P = 0.032) and better sparing of the rectum, bladder and small intestine (rectum: 41.6 ± 6.8 vs. 50.8 ± 3.2, P = 0.016; bladder: 40.2 ± 2.9 vs. 51.4 ± 1.8, P = 0.007; small intestine: 22.3 ± 2.6 vs. 35.8 ± 3.9, P = 0.004). The mean dose delivered to the planning target volume (PTV) was significantly higher in the RF-IMRT group than that in the c-RT group (60.8 vs. 51.2 Gy, P = 0.006). The RF-IMRT patients experienced significantly lower acute and chronic toxicities with comparable short-term effects than did those treated with conventional RT (P > 0.05). No significant differences were found between the two groups for 1-, 3-, and 5-year overall survival (OS) rates, while a significantly higher progression-free survival (PFS, 65.2% vs. 46.2%, P = 0.031) rate was observed in the RF-IMRT group.

CONCLUSIONSRF-IMRT yields higher dose distributions and lower toxicities compared with conventional RT, and both the tumor target volume and pelvic lymphatic drainage region achieve curative dose irradiation, the adjacent organs at risk are well protected, and with tolerable adverse reactions. Yet, RF-IMRT provides comparable clinical outcomes and higher PFS.

Adenocarcinoma ; drug therapy ; pathology ; radiotherapy ; Brachytherapy ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; radiotherapy ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Neoplasm Staging ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Remission Induction ; Survival Rate ; Uterine Cervical Neoplasms ; drug therapy ; pathology ; radiotherapy

OBJECTIVETo investigate the value of intensity modulated radiation therapy (IMRT) for patient with gynecological malignancies after treatment of hysterectomy and chemotherapy/radiotherapy.

METHODSAll 32 patients with cervical or endometrial cancer after hysterectomy received full course IMRT after 1 to 3 cycles of chemotherapy (Karnofsky performance status(KPS) > or =70). Seventeen of these patients underwent postoperative preventive irradiation and the other 15 patients were pelvic wall recurrence and/or retroperitoneal lymph node metastasis, though postoperative radiotherapy and/or chemotherapy had been given after operation.

RESULTSThe median dose delivered to the PTV was 56.8 Gy for preventive irradiation, and 60.6 Gy for pelvic wall recurrence or retroperioneal lymph node metastasis irradiation. It was required that 90% of iso-dose curve could covere more than 99% of GTV. However, The mean dose irradiated to small intestine, bladder, rectum, kidney and spinal cord was 21.3 Gy, 37.8 Gy, 35.3 Gy, 8.5 Gy, 22.1 Gy, respectively. Fourteen patients presented grade I (11 patients) or II (3 patients) digestive tract side-effects, Five patients developed grade I or II bone marrow depression. Twelve patients had grade I skin reaction. The overall 1-year survival rate was 100%. The 2- and 3- year survival rate for preventive irradiation were both 100%, but which was 5/7 and 3/6 for the patients with pelvic wall recurrence or retroperioneal lymph node metastasis.

CONCLUSIONIntensity modulated radiation therapy can provide a better dose distribution than traditional radiotherapy for both prevention and pelvic wall recurrence or retroperioneal lymph node metastasis. The toxicity is tolerable. The adjacent organs at risk can well be protected.

Adult ; Aged ; Combined Modality Therapy ; Diarrhea ; etiology ; Endometrial Neoplasms ; drug therapy ; radiotherapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Survival Analysis ; Uterine Cervical Neoplasms ; drug therapy ; radiotherapy ; surgery

The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8-20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%); stage III, 14 (41.2%); and stage IV, 19 (55.9%). All patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64-68 Gy in 29-31 fractions to the nasopharyngeal gross target volume. Within the median follow-up of 52 months (range, 9-111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3-4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1-2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure.
Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma ; Child ; Cisplatin ; administration & dosage ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; etiology ; Lung Neoplasms ; secondary ; Male ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neutropenia ; etiology ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Retrospective Studies ; Stomatitis ; etiology ; Survival Rate ; Xerostomia ; etiology ; Young Adult

BACKGROUND AND OBJECTIVERadiotherapy is effective in treating nasopharyngeal carcinoma (NPC). This study evaluated the treatment efficacy, toxicity, and prognostic factors of intensity-modulated radiotherapy (IMRT) in the treatment NPC.

METHODSBetween September 2003 and September 2006, 305 patients with NPC were treated with IMRT in Fujian Provincial Cancer Hospital. IMRT was delivered as follows: gross tumor volume (GTV) received 66.0-69.8 Gy in 30-33 fractions, high-risk clinical target volume (CTV-1) received 60.0-66.65 Gy, low-risk clinical target volume (CTV-2) and clinical target volume of cervical lymph node regions (CTV-N) received 54.0-55.8 Gy. Patients with stages III or IV disease also received cisplatin-based chemotherapy. All patients were assessed for local-regional control, survival, and toxicity.

RESULTSWith a median follow-up of 35 months (range, 5-61 months), there were 16, 8, and 39 patients who had developed local, regional, and distant recurrence, respectively. The 3-year rates of local control, regional control, metastasis-free survival, disease-free survival, and overall survival were 94.3%, 97.7%, 86.1%, 80.3%, and 89.1%, respectively. Multivariate analyses revealed that T-classification had no predictive value for local control and survival, whereas N-classification was a significant prognostic factor for overall survival (P < 0.001), metastasis-free survival (P < 0.001), and disease-free survival (P = 0.003). For stages III-IV disease, concurrent and adjuvant chemotherapy did not influence prognosis. The most severe acute toxicities included Grade III mucositis in 14 patients (4.6%), Grade III skin desquamation in 90 (29.5%), and Grades III-IV leucocytopenia in 20 (6.5%). There were 7% patients with Grade II xerostomia after 2 years of IMRT, no Grades 3 or 4 xerostomia was detected.

CONCLUSIONSIMRT provided favorable locoregional control and survival rates for patients with NPC, even in those with locally advanced disease. The acute and late toxicities were acceptable. N-classification was the main factor of prognosis. Further study is needed on chemotherapy for patients with NPC.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; etiology ; Lymphatic Metastasis ; Male ; Middle Aged ; Mucositis ; etiology ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Retrospective Studies ; Survival Rate ; Xerostomia ; etiology ; Young Adult

OBJECTIVETo evaluate the efficacy and toxicity of Yanshu injection (a compound Chinese traditional medicine from Sophora flauescens Ait) combined with concomitant radiochemotherapy in patients with stage III nasopharyngeal carcinoma.

METHODSSixty patients with stage III nasopharyngeal carcinoma were randomized into Yanshu group and control group (n = 30, each). Patients in the Yanshu group received Yanshu injection in addition to intensity modulated radiation therapy (IMRT) and concomitant chemotherapy, and those in the control group were treated with IMRT and concurrent chemotherapy.

RESULTSThe 1-year, 2-year, 3-year and 4-year overall survival rates were 100%, 93.3%, 86.7%, 80.0% for Yanshu group, and 96.7%, 90.0%, 83.3%, 76.7% for the control group, respectively, with no significant difference between the two groups (P = 0.565). The 1-year, 2-year, 3-year and 4-year progression-free survival rates were 96.7%, 90.0%, 83.3%, 70.0% for Yanshu group, and 90.0%, 86.7%, 76.7%, 66.7% for control group, respectively, with no significant difference (P = 0.554). However, the reaction of mucosa of oral cavity, myelosuppression and thrombocytopenia in the Yanshu group were significantly lower than that in the control group (P < 0.05). The quality of life of the patients in the Yanshu group was significantly higher than that in the control group (P < 0.05).

CONCLUSIONSYanshu injection combined with radiochemotherapy in patients with stage III nasopharyngeal carcinoma show a good efficacy and can reduce the side effects of radiochemotherapy of nasopharygeal carcinoma, and improve the quality of life of the patients.

Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; therapy ; Chemoradiotherapy ; methods ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Disease-Free Survival ; Drugs, Chinese Herbal ; adverse effects ; isolation & purification ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; chemically induced ; etiology ; Male ; Medicine, Chinese Traditional ; Mucositis ; chemically induced ; etiology ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; therapy ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Plants, Medicinal ; chemistry ; Quality of Life ; Radiotherapy, Intensity-Modulated ; adverse effects ; Sophora ; chemistry ; Survival Rate ; Thrombocytopenia ; chemically induced ; etiology