Intensity-modulated radiation therapy in oropharyngeal carcinoma: Effect of tumor volume on clinical outcomes

Benjamin H. Lok, Jeremy Setton, Nicola Caria, Jonathan Romanyshyn, Suzanne L. Wolden, Michael J. Zelefsky, Jeffery Park, Nicholas Rowan, Eric J. Sherman, Matthew G. Fury, Alan Ho, David G. Pfister, Richard J. Wong, Jatin P. Shah, Dennis H. Kraus, Zhigang Zhang, Karen D. Schupak, Daphna Y. Gelblum, Shyam Rao, Nancy Y. Lee

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Purpose: To analyze the effect of primary gross tumor volume (pGTV) and nodal gross tumor volume (nGTV) on treatment outcomes in patients treated with definitive intensity-modulated radiation therapy (IMRT) for oropharyngeal cancer (OPC). Methods and Materials: Between September 1998 and April 2009, a total of 442 patients with squamous cell carcinoma of the oropharynx were treated with IMRT with curative intent at our center. Thirty patients treated postoperatively and 2 additional patients who started treatment more than 6 months after diagnosis were excluded. A total of 340 patients with restorable treatment plans were included in this present study. The majority of the patients underwent concurrent platinum-based chemotherapy. The pGTV and nGTV were calculated using the original clinical treatment plans. Cox proportional hazards models and log-rank tests were used to evaluate the correlation between tumor volumes and overall survival (OS), and competing risks analysis tools were used to evaluate the correlation between local failure (LF), regional failure (RF), distant metastatic failure (DMF) vs. tumor volumes with death as a competing risk. Results: Median follow-up among surviving patients was 34 months (range, 5-67). The 2-year cumulative incidence of LF, RF and DF in this cohort of patients was 6.1%, 5.2%, and 12.2%, respectively. The 2-year OS rate was 88.6%. Univariate analysis determined pGTV and T-stage correlated with LF (p < 0.0001 and p = 0.004, respectively), whereas nGTV was not associated with RF. On multivariate analysis, pGTV and N-stage were independent risk factors for overall survival (p = 0.0003 and p = 0.0073, respectively) and distant control (p = 0.0008 and p = 0.002, respectively). Conclusions: In this cohort of patients with OPC treated with IMRT, pGTV was found to be associated with overall survival, local failure, and distant metastatic failure.

Original languageEnglish (US)
Pages (from-to)1851-1857
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number5
DOIs
StatePublished - Apr 1 2012
Externally publishedYes

Fingerprint

Tumor Burden
radiation therapy
Radiotherapy
tumors
cancer
Carcinoma
Oropharyngeal Neoplasms
Survival
rank tests
deuterium fluorides
Oropharynx
chemotherapy
Platinum
Proportional Hazards Models
death
hazards
Squamous Cell Carcinoma
platinum
Therapeutics
Multivariate Analysis

Keywords

  • Clinical outcomes
  • Head-and-neck cancer
  • IMRT
  • Oropharyngeal cancer
  • Tumor volume

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Intensity-modulated radiation therapy in oropharyngeal carcinoma : Effect of tumor volume on clinical outcomes. / Lok, Benjamin H.; Setton, Jeremy; Caria, Nicola; Romanyshyn, Jonathan; Wolden, Suzanne L.; Zelefsky, Michael J.; Park, Jeffery; Rowan, Nicholas; Sherman, Eric J.; Fury, Matthew G.; Ho, Alan; Pfister, David G.; Wong, Richard J.; Shah, Jatin P.; Kraus, Dennis H.; Zhang, Zhigang; Schupak, Karen D.; Gelblum, Daphna Y.; Rao, Shyam; Lee, Nancy Y.

In: International Journal of Radiation Oncology Biology Physics, Vol. 82, No. 5, 01.04.2012, p. 1851-1857.

Research output: Contribution to journalArticle

Lok, BH, Setton, J, Caria, N, Romanyshyn, J, Wolden, SL, Zelefsky, MJ, Park, J, Rowan, N, Sherman, EJ, Fury, MG, Ho, A, Pfister, DG, Wong, RJ, Shah, JP, Kraus, DH, Zhang, Z, Schupak, KD, Gelblum, DY, Rao, S & Lee, NY 2012, 'Intensity-modulated radiation therapy in oropharyngeal carcinoma: Effect of tumor volume on clinical outcomes', International Journal of Radiation Oncology Biology Physics, vol. 82, no. 5, pp. 1851-1857. https://doi.org/10.1016/j.ijrobp.2011.03.029
Lok, Benjamin H. ; Setton, Jeremy ; Caria, Nicola ; Romanyshyn, Jonathan ; Wolden, Suzanne L. ; Zelefsky, Michael J. ; Park, Jeffery ; Rowan, Nicholas ; Sherman, Eric J. ; Fury, Matthew G. ; Ho, Alan ; Pfister, David G. ; Wong, Richard J. ; Shah, Jatin P. ; Kraus, Dennis H. ; Zhang, Zhigang ; Schupak, Karen D. ; Gelblum, Daphna Y. ; Rao, Shyam ; Lee, Nancy Y. / Intensity-modulated radiation therapy in oropharyngeal carcinoma : Effect of tumor volume on clinical outcomes. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 82, No. 5. pp. 1851-1857.
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T2 - Effect of tumor volume on clinical outcomes

AU - Lok, Benjamin H.

AU - Setton, Jeremy

AU - Caria, Nicola

AU - Romanyshyn, Jonathan

AU - Wolden, Suzanne L.

AU - Zelefsky, Michael J.

AU - Park, Jeffery

AU - Rowan, Nicholas

AU - Sherman, Eric J.

AU - Fury, Matthew G.

AU - Ho, Alan

AU - Pfister, David G.

AU - Wong, Richard J.

AU - Shah, Jatin P.

AU - Kraus, Dennis H.

AU - Zhang, Zhigang

AU - Schupak, Karen D.

AU - Gelblum, Daphna Y.

AU - Rao, Shyam

AU - Lee, Nancy Y.

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N2 - Purpose: To analyze the effect of primary gross tumor volume (pGTV) and nodal gross tumor volume (nGTV) on treatment outcomes in patients treated with definitive intensity-modulated radiation therapy (IMRT) for oropharyngeal cancer (OPC). Methods and Materials: Between September 1998 and April 2009, a total of 442 patients with squamous cell carcinoma of the oropharynx were treated with IMRT with curative intent at our center. Thirty patients treated postoperatively and 2 additional patients who started treatment more than 6 months after diagnosis were excluded. A total of 340 patients with restorable treatment plans were included in this present study. The majority of the patients underwent concurrent platinum-based chemotherapy. The pGTV and nGTV were calculated using the original clinical treatment plans. Cox proportional hazards models and log-rank tests were used to evaluate the correlation between tumor volumes and overall survival (OS), and competing risks analysis tools were used to evaluate the correlation between local failure (LF), regional failure (RF), distant metastatic failure (DMF) vs. tumor volumes with death as a competing risk. Results: Median follow-up among surviving patients was 34 months (range, 5-67). The 2-year cumulative incidence of LF, RF and DF in this cohort of patients was 6.1%, 5.2%, and 12.2%, respectively. The 2-year OS rate was 88.6%. Univariate analysis determined pGTV and T-stage correlated with LF (p < 0.0001 and p = 0.004, respectively), whereas nGTV was not associated with RF. On multivariate analysis, pGTV and N-stage were independent risk factors for overall survival (p = 0.0003 and p = 0.0073, respectively) and distant control (p = 0.0008 and p = 0.002, respectively). Conclusions: In this cohort of patients with OPC treated with IMRT, pGTV was found to be associated with overall survival, local failure, and distant metastatic failure.

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KW - Clinical outcomes

KW - Head-and-neck cancer

KW - IMRT

KW - Oropharyngeal cancer

KW - Tumor volume

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