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Abstract Background Studies have shown mixed results concerning the role of primary tumor volume (TV) and metastatic lymph node (NV) volume in response to the curative effect of definitive radiotherapy for locally advanced head and neck squamous cell carcinoma (LAHNSCC). Objective We aimed to evaluate the impact of TV and NV on the efficacy of radical radiotherapy in LAHNSCC patients, with the goal of guiding individualized therapy. Patients and methods Patients with LAHNSCC who received radical radiation therapy and were reexamined within 6 months post-therapy from January 2012 to December 2021 were selected. The volumes of the primary tumors and metastatic lymph nodes were calculated by software and then were divided into a large TV group vs small TV group and a large NV group vs small NV group according to the relationship with the median. Additionally, patients who received concurrent chemoradiotherapy (CCRT) or not were divided into the CCRT group and the radiotherapy (RT) group. Patients with lymph node metastasis were divided into node concurrent chemotherapy (N-CCRT) group and a node metastatic chemotherapy (N-RT) group according to whether they received concurrent chemotherapy or not. The volume shrinkage rate (VSR), objective response rate (ORR), local control rate (LCR) and overall survival (OS) were recorded and analyzed. Results 96 patients were included in the primary tumor volume group, and 73 patients were included in the metastatic lymph node group. Receiver operating characteristic (ROC) curves were constructed for objective remission (OR) endpoints, and a volume threshold was defined for TV and NV patients. The threshold primary tumor volume was 32.45 cm3, and the threshold metastatic lymph node volume was 6.05 cm3.The primary TV shrinkage rates of the small TV and the large TV groups were basically the same, P = 0.801. Similarly, the ORR and LCR were not significantly different between the small TV group and the large TV group (P ORR = 0.118, P LCR = 0.315). Additionally, the TV shrinkage rate did not significantly differ between the CCRT group and the RT group, P = 0.133. Additionally, there was no significant difference in ORR or LCR in CCRT group (P ORR = 0.057, P LCR = 0.088). However, the metastatic lymph node volume shrinkage rate in the small NV group was significantly greater than that in the large NV group (P = 0.001). The ORR and LCR of the small NV subgroup were significantly greater than those of the large NV subgroup (P ORR = 0.002, P LCR = 0.037). Moreover, compared with that of the N-RT group, the NV shrinkage rate of the N-CCRT group was 84.10 ± s3.11%, and the shrinkage rate was 70.76 ± s5.77% (P = 0.047). For the ORR and LCR, the N-CCRT group and N-RT group were significantly different (P ORR = 0.030, P LCR = 0.037). The median OS of the whole group was 26 months. However, neither TV/NV nor concurrent chemotherapy seemed to influence OS. Conclusion Primary tumor volume is not a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Nevertheless, metastatic lymph nodes are a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Patients with smaller lymph nodes have better local control.

Objective: The role of Primary Tumor Volume (PTV) in Nasopharyngeal Carcinoma (NPC) treated with Volumetric Modulated Arc Therapy (VMAT) is still unclear. The aim of this study was to access the effect of PTV in prognosis prediction of nasopharyngeal carcinoma in era of VMAT. Methods: Between January 20 and November 2011, 498 consecutive NPC patients with stage I–IVA disease who received VMAT at a single center were retrospectively analyzed. Receiver Operating Characteristic (ROC) was performed to access the cut-off point of PTV. Univariate Kaplan-Meier and multivariate Cox regression analyses were used to evaluate prognostic value for PTV. The Propensity Score Matching (PSM) was used to adjust baseline potential confounders. Results: The 5-year Locol-Regional Failure-Free (L-FFR), Distant Failure-Free Survival (D-FFR), Disease-Free Survival (DFS) and Overall Survival (OS) were 90.6%, 83.7%, 71.5% and 79.3%, respectively. Before PSM, the 5-year L-FFR, D-FFR, DFS, OS rates for NPC patients with PTV ≤ 38 mL vs. PTV > 38 mL were 94.1% vs. 90.4% (p = 0.063), 87.9% vs. 76.3% (p 38 mL may be considered as an indicator of the clinical stage of nasopharyngeal carcinoma. Level of evidence: III.

OBJECTIVES: To explore the effect of tumor and normal lung volumes on lung volume-dose parameters in patients with non-small-cell lung cancer (NSCLC) who had undergone intensity-modulated radiation therapy (IMRT). METHODS: The clinical data of 208 patients with NSCLC who underwent radical IMRT between June 2014 and June 2018 were retrospectively analyzed. A regression model curve was used to evaluate the effect of tumor and normal lung volumes on normal lung relative volumes receiving greater than 5 and 20 Gy (V5, V20), on mean lung dose (MLD), and on absolute volumes spared from greater than 5 and 20 Gy (AVS5, AVS20). RESULTS: The V5, V20, and MLD of the bilateral lung were fitted to a quadratic equation curve with the change in tumor volume, which increased initially and then decreased when the tumor volume increased. The V5, V20, and MLD of the lung reached their apex when the tumor volumes were 288.07, 341.69, and 326.83 cm3, respectively. AVS5 and AVS20 decreased in a logarithmic curve with an increase in tumor volume. The V5, V20, and MLD of the small normal lung volume group were all significantly higher than those of the large normal lung volume group (p

Lu-Lu Ye,1,2,* Jia Rao,2,3,* Xing-Wen Fan,1,2 Qing-Hai Ji,2,4 Chao-Su Hu,1,2 Hong-Mei Ying1,2 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China; 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China; 3Department of Pathology, 4Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China *These authors contributed equally to this work Purpose: To analyze the potential variables affecting the survival of patients undergoing primary surgery for hypopharyngeal squamous cell carcinoma.Patients and methods: Between August 2007 and December 2016, 93 patients with primary hypopharyngeal squamous cell carcinomas undergoing radical surgery at Fudan University Shanghai Cancer Center were reviewed. The clinicopathological features were analyzed retrospectively. The optimal cutoff values were determined based on the receiver operating characteristic curve analysis. Pearson correlation coefficients were used to assess the correlations between variables. The Kaplan–Meier and Cox proportional hazard methods were used to evaluate the impact of variables on overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS).Results: Cox multivariate analysis revealed that a depth of invasion (DOI) ≥ 4.3 mm was correlated with inferior OS (P=0.045), DSS (P=0.046), and DFS (P=0.046). A primary tumor volume (PTV) ≥0.36 mL was related to poor OS (P=0.018), DSS (P=0.026), and DFS (P=0.036). A lymph node density (LND) ≥0.07 was also associated with worse OS (P=0.014) and DSS (P=0.045). Moreover, additional prognostic value was observed in the combined use of PTV and LND.Conclusion: The DOI, PTV, and LND obtained from the surgical specimens could provide additional valuable information for prognostic stratification and allowed the more appropriate selection of suitable candidates for more aggressive adjuvant therapy. Keywords: hypopharynx, surgery, depth of invasion, primary tumor volume, lymph node density, survival

Background: Nasopharyngeal carcinoma (NPC) associated with Epstein-Barr virus (EBV) chronic infection is a common head and neck malignancy in South China and Indonesia. Although radiation and chemotheraphy is the main theraphy, it requires repeated and invasive biopsy for pathological evaluation. Therefore, a marker is required for screening including the level of anti early antigen imunoglobin a serology level. Method: Pre-pots test, longitudinal cohort design. The PTV of 18 samples were examined using CT scan, while their serum EBV anti EA IgA level were examined using pre and post three series-cisplatin-paclitaxel chemotherapy ELISA. Results: Although there was no significant changes in the level of anti EA IgA, however we found a decrease in the mean of pre-chemotherapy anti EA IgA level from 136.49 U/ml to 124.61 U/ml. There was significant changes in the VTP in pre and post-chemotherapy (p<0.05). The mean of VTP in pre-chemotherapy was 66.26 cm3 (SD-38.61 cm3), while in post-chemotherapy was 31.64 cm3 (SD-27.5 cm3). The delta mean of changes in anti EA IgA level was 11.8 U/ml and in VTP was 34.62 cm3. No correlation was found between the changes of anti EA IgA and the changes of VTP in post-chemotheraphy (p>0.05). However, decreases were found in the level of EBV EA IgA and PTV in pre and post NPC patients. Conclusion: There were decreases of serum EBV EA IgA level and PTV in pre and post-chemotherapy NPC patients. [ABSTRACT FROM AUTHOR]

Background: The prognostic value of primary tumor volume (TV) in nasopharyngeal carcinoma (NPC) has been confirmed. However, studies of the prognosis value of tumor burden, including TV and nodal volume (NV), have been relatively infrequent. Therefore, the aim of this study was to evaluate the prognostic value of tumor burden in NPC patients treated with intensity-modulated radiotherapy.Methods: Receiver operating characteristics curves were generated to determine rational cutoff points for TV and NV. The volumes identified included 12.5, 25.0, and 50.0 mL, and 0, 12.5, and 25 mL, respectively. According to these cutoff volumes, four subgroups were established for TV as TV1–TV4, and four subgroups were established for NV as NV0–NV3. Then, the entire cohort (992 NPC patients) was divided into 16 subgroups according to these four levels of TV and NV. Based on similarities in the 5-year overall survival (OS) rates for these 16 subgroups, four patient groups were established, G1–G4.Results: The mean TV and NV values for our cohort were 39.5±30.8 mL and 16.5±17.6 mL, respectively. The 5-year distant failure-free rate, the 5-year disease-free survival rate, and the 5-year OS rate for G3 and G4 were significantly lower than those for G1 and G2. In particular, the OS curves of the four patient groups were significantly separated. A multivariate analysis identified TV >50 mL, T-stage (3–4), and N-stage (2–3) as adverse prognostic factors for OS.Conclusions: The results of this study demonstrate that tumor burden has a significant prognostic value for NPC patients treated with intensity-modulated radiotherapy. Hence, tumor burden, including TV and NV, should be incorporated into the current staging system for NPC to improve prognostic significance. [ABSTRACT FROM AUTHOR]

Objective: To delineate the prognostic value of primary gross tumor volume (GTVp) for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy.Study Design: Analysis of prognostic variables in a prospective cohort.Setting: Department of Radiotherapy, First Affiliated Hospital of Guangxi Medical University, China.Subjects and Methods: Between January 2006 and August 2008, 249 patients with stage III-IVb NPC, all treated by intensity-modulated radiotherapy plus concurrent chemotherapy, were included in this multicenter prospective study. GTVp was measured with treatment-planning computed tomography or magnetic resonance imaging scans.Results: GTVp was significantly associated with locoregional control, distant metastasis, and overall survival for patients with advanced NPC. Furthermore, T classification was not an independent prognostic factor. In receiver operator receiver operating characteristic curve analysis, 33 mL was determined as the cutoff points of GTVp for OS and locoregional control. Patients with a GTVp ≥33 mL had poorer OS, worse locoregional control, and more distant metastasis than patients with a GTVp <33 mL (P = .006, .009, .002, and .007, respectively).Conclusions: GTVp had significant prognostic value for patients with advanced NPC. The incorporation of GTVp could improve the current TNM classification system. [ABSTRACT FROM AUTHOR]

Background The impact of primary tumor volume (pTV) on local control after definitive radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC) is unclear. Methods Pertinent literature was reviewed to address the impact of pTV on local control after definitive RT for HNSCC. Results Reproducibility of pTV calculations is probably influenced by interobserver variability and may be reduced by relying on experienced observers. The impact of pTV on local control after definitive RT is probably influenced by primary site. A relatively limited impact of pTV on local control after RT for oropharyngeal squamous cell carcinomas (SCCs) might be attributable to human papillomavirus (HPV) positivity. Conclusion pTV may be a useful parameter to select patients for treatment with definitive RT, particularly for those with laryngeal SCCs. Patients with high-volume primary cancers, in which the probability of local control with a functional larynx is low, are likely better treated with surgery. © 2013 Wiley Periodicals, Inc. Head Neck 36: 1363-1367, 2013 [ABSTRACT FROM AUTHOR]

Purpose: We aimed to analyze prognostic factors in patients with nasopharyngeal carcinoma (NPC) treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT); in addition, we aimed to elucidate the value of primary gross tumor volume (GTVp) in predicting prognosis of patients. Methods: Between February 2001 and December 2008, 321 patients with NPC treated with concurrent chemotherapy and IMRT were analyzed retrospectively. GTVp was calculated from treatment planning computed tomography scans. A receiver operating characteristics (ROC) curve was used to determine the best cutoff point of GTVp. Results: The 5-year local failure-free survival (LFFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) for NPC patients were 93.8, 80.1, 73.0, and 83.7 %, respectively. Univariate and multivariate analyses indicated that GTVp had exhibited a statistically significant correlation with LFFS, DMFS, DFS, and OS ( P < 0.05, all), whereas T classification was not an independent prognostic factor. According to ROC curve analysis, 49 and 19 mL were determined as the cutoff points of GTVp for local control and distant metastasis, respectively. Based on this, 321 patients were divided into three volume subgroups. LFFS, DMFS, DFS, and OS demonstrated significant differences among patients in different volume subgroups ( P < 0.001, all) and were superior to T classification for predicting prognosis of NPC patients. Conclusions: Primary gross tumor volume is an independent prognostic factor in local control, distant metastasis, disease-free survival, and overall survival in NPC. An adjusted TNM staging system that includes GTVp as a quantitative indicator to evaluate prognosis is warranted. [ABSTRACT FROM AUTHOR]

Background: To investigate the interfraction displacement and volume variation of primary thoracic esophagus carcinoma with enhanced four-dimensional computed tomography (4DCT) scanning during fractionated radiotherapy.Methods: 4DCT data sets were acquired at the time of treatment simulation and every ten fraction for each of 32 patients throughout treatment. Scans were registered to baseline (simulation) 4DCT scans by using bony landmarks. The gross tumor volumes (GTVs) were delineated on each data set. Coordinates of the GTV centroids were acquired on each respiration phase. Distance between center of the GTV contour on the simulation scan and the centers on subsequent scans were used to assess interfraction displacement between fractions. Volumes were constructed using three approaches: The GTV delineated from the maximum intensity projection (MIP) was defined IGTVMIP, all 10 GTVs were combined to form IGTV10, GTVmean was the average of all 10 phases of each GTV.Results: Interfraction displacement in left-right (LR), anterior-posterior (AP), superior-inferior (SI) directions and 3D vector were 0.13 ± 0.09 cm, 0.16 ± 0.12 cm, 0.34 ± 0.26 cm and 0.43 ± 0.24 cm, respectively between the tenth fraction and simulation 4DCT scan. 0.14 ± 0.09 cm, 0.19 ± 0.16 cm, 0.45 ± 0.43 cm and 0.56 ± 0.40 cm in LR, AP, SI and 3D vector respectively between the twentieth fraction and simulation 4DCT scan. Displacement in SI direction was larger than LR and AP directions during treatment. For distal esophageal cancer, increased interfraction displacements were observed in SI direction and 3D vector (P = 0.002 and P = 0.001, respectively) during radiotherapy. The volume of GTVmean, IGTVMIP, and IGTV10 decreased significantly at the twentieth fraction for middle (median: 34.01%, 33.09% and 28.71%, respectively) and distal (median: 22.76%, 25.27% and 23.96%, respectively) esophageal cancer, but for the upper third, no significant variation were observed during radiotherapy.Conclusions: Interfractional displacements in SI direction were larger than LR and AP directions. For distal location, significant changes were observed in SI direction and 3D vector during radiotherapy. For middle and distal locations, the best time to reset position should be selected at the twentieth fraction when the primary tumor target volume changed significantly, and it was preferable to guide target correction and planning modification. [ABSTRACT FROM AUTHOR]

Background: To retrospectively analyze whether primary tumor volume and primary nodal volume could be considered independent prognostic factors for nasopharyngeal carcinoma treated with intensity-modulated radiation therapy.Methods: Three hundred sixty-three consecutive nasopharyngeal carcinoma (NPC) patients who were stage I-IVa+b and treated with intensity-modulated radiotherapy (IMRT) in our center from October 2003 to October 2005 were analyzed retrospectively. The predictive ability of gender, age, T and N stage, combined chemotherapy, primary tumor and nodal volume for the 5-year local control (LC), distant-metastasis free survival (DMFS) and overall survival (OS) rate were investigated. Primary tumor and nodal volume were measured based on registration of magnetic resonance imaging (MRI) with contrast-enhanced computed tomography (CT) images. The Kaplan-Meier method was used for survival analysis, the log-rank test was used for univariate analyses and the Cox proportional hazard model was used for multivariate prognostic analyses.Results: The mean value of primary tumor and nodal volume were 31.5 ml and 9.7 ml. The primary tumor and nodal volume were respectively divided into four groups for analysis (primary tumor volume: TV1≤20 ml, 2040 ml; primay nodal volume: NV1≤5 ml, 520 ml). In univariate analysis, the 5-year LC and DMFS rate for TV4 was significantly decreased compared to the other groups (LC: p<0.001, DMFS: p=0.001), the 5-year OS rate for TV3 and TV4 were significantly decreased compared to other two subgroups (p=0.002) and the 5-year regional control (RC), DMFS and OS rate for NV3 and NV4 were significantly less than NV1 and NV2 (RC: p=0.002, DMFS: p=0.01, OS: p=0.014). Multivariate analysis showed that TV>40 ml was an adverse prognostic factor for the 5-year local regional control (LRC) rate (RR 2.454, p=0.002). Primary nodal volume had no statistical significance in predicting 5-year LRC, DMFS and OS rate in multivariate analysis.Conclusions: Primary tumor volume could predict LRC rate of NPC patients, and the primary tumor volume of 40 ml may be the cut-off. Primary nodal volume may have predictive significance, but more data are needed. These factors should be considered in the TNM staging system of NPC for better estimates of prognosis. [ABSTRACT FROM AUTHOR]

Background: The correlation between primary tumor volume and nasopharyngeal carcinoma (NPC) UICC 2002 T classification, N classification and distant metastasis after radiation therapy was discussed to provide further evidence for the inclusion of tumor volume into the TNM classification staging system. Methods: Between February 2001 and December 2008, 666 patients with NPC treated with intensity-modulated radiation therapy (IMRT) were analyzed retrospectively. Primary gross tumor volume was calculated from treatment planning computed tomography scans. The Kruskal-Wallis and Mann-Whitney tests were used for comparison of continuous variables and the chi-square test was used for categorical variables. A logistic regression model was used for multivariate analysis. Results: Median primary tumor volume of the 666 patients was 20.35 ml (range, 0.44 - 192.63 ml), and it gradually increased with T classification. Statistically significant differences in tumor volume were observed between patients with different T classifications (p < 0.001). The cervical lymph node metastasis rate was 64.7% (430/666); the differences in primary tumor volume between patients with or without lymph node metastasis were statistically significant (p < 0.001). Posttreatment distant metastasis occurred in 100 NPC patients, and the five-year distant metastasis-free survival was 84.2%. Univariate and multivariate analyses showed that N classification (p < 0.001) and tumor volume (p = 0.007) were the main factors influencing distant metastasis. Conclusion: Tumor volume was correlated with T classification, cervical lymph node mestastasis and distant metastasis after radiation therapy in nasopharyngeal carcinoma, suggesting that tumor volume should be included into the TNM staging system. [ABSTRACT FROM AUTHOR]

Background This study was undertaken to analyze the correlation between primary gross tumor volume (GTVp) and prognosis in patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiation therapy (IMRT). Methods Between February 2001 and December 2006, 305 patients with NPC treated with IMRT were analyzed retrospectively. GTVp was calculated from treatment planning CT scans. Results Univariate and multivariate analyses indicated that GTVp had a statistically significant correlation to local control, distant metastasis, and overall survival in patients with NPC, whereas T classification was not an independent prognostic factor. Among patients classified with N0-1 and N2-3, there were significant differences in the rates of distant metastasis between those with GTVp smaller and larger than 25 mL ( p < .001 and p = .002, respectively). Conclusions GTVp is highly significant in evaluating local control, distant metastasis, and overall survival of patients with NPC treated with IMRT. Therefore, it is recommended that GTVp be included in the new TNM classification system. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: To evaluate the prognostic value of gross primary tumor volume (GTV-P) in nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT). Methods and materials: A total of 694 nonmetastatic and histologically proven NPC patients who underwent IMRT were retrospectively reviewed. Samples were split randomly into a training set (n =232) and a test set (n =462) to analysis. The receiver operating characteristic (ROC) curves were calculated to identify the cut-off point and test the prognostic validity of the GTV-P. The correlations between GTV-P and the American Joint Committee on Cancer (AJCC) disease stages were also analyzed. Results: The 5-year disease-free survival (DFS), overall survival (OS), local relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) rates for NPC patients with GTV-P<19 vs. ⩾19ml were 94.9% vs. 64.8%, 97.0% vs. 76.4%, 98.2% vs. 92.5% and 97.1% vs. 75.2%, respectively (all P < 0.05) in all patients. Multivariate analysis indicated GTV-P was an independent prognostic factor. The ROC curve verified that the predictive ability of T classifications was improved when combined with GTV-P (P <0.001). Conclusions: GTV-P is an independent prognostic indicator for treatment outcome after IMRT, and significantly improves the prognostic validity of T classifications in NPC. [Copyright &y& Elsevier]

Purpose: The tumor volume has been established as a significant predictor of outcomes among patients with head-and-neck cancer undergoing radiotherapy alone. The present study attempted to add to the existing data on tumor volume as a prognostic factor among patients undergoing chemoradiotherapy. Methods and Materials: A total of 78 patients who had undergone definitive chemoradiotherapy for Stage III-IV squamous cell cancer of the hypopharynx, oropharynx, and larynx were identified. The primary tumor volumes were calculated from the treatment planning computed tomography scans, and these were correlated to the survival and tumor control data obtained from the retrospective analysis. Results: The interval to progression correlated with the primary tumor volume (p = .007). The critical cutoff point for the tumor volume was identified as 35 cm3, and patients with a tumor volume <35 cm3 had a significantly better prognosis than those with a tumor volume >35 cm3 at 5 years (43% vs. 71%, p = .010). Longer survival was also correlated with smaller primary tumor volumes (p = .022). Similarly, patients with a primary tumor volume <35 cm3 had a better prognosis in terms of both progression-free survival (61% vs. 33%, p = .004) and overall survival (84% vs. 41%, p = < .001). On multivariate analysis, the primary tumor volume was the best predictor of recurrence (hazard ratio 4.7, 95% confidence interval 1.9–11.6; p = .001) and survival (hazard ratio 10.0, 95% confidence interval 2.9–35.1; p = < .001). In contrast, the T stage and N stage were not significant factors. Analysis of variance revealed that tumors with locoregional failure were on average 21.6 cm3 larger than tumors without locoregional failure (p = .028) and 27.1-cm3 larger than tumors that recurred as distant metastases (p = .020). Conclusion: The results of our study have shown that the primary tumor volume is a significant prognostic factor in patients with advanced cancer of the head and neck undergoing definitive chemoradiotherapy and correlated with the treatment outcomes better than the T or N stage. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the impact of invasion of the prevertebral or parapharyngeal spaces and large tumor volume on treatment outcomes in patients with nasopharyngeal carcinoma (NPC). Methods: A total of 105 patients with newly diagnosed NPC were enrolled in this study. TNM stage and presence of invasion of the prevertebral or parapharyngeal spaces were recorded. All patients received a total dose of 70–75Gy. Results: After controlling for age, sex, and chemotherapy status, invasion of the prevertebral or parapharyngeal spaces and large primary tumor volume produced a significantly increased hazard ratio for distant metastasis and recurrence. We defined patients with two or more such prognostic factors as high-risk patients, in whom the 3-year metastasis-free survival rate, with and without adjuvant chemotherapy, was 100% and 69.6%, respectively (P =0.02). Their 3-year recurrence-free survival rate, with and without adjuvant chemotherapy, was 93.3% and 70.2% (P =0.09). This benefit was not observed in low-risk NPC patients. Conclusion: NPC patients with any two or more of the factors, involvement of the prevertebral space, large primary tumor volume, or advanced parapharyngeal space invasion, had more recurrence and poor survival rates and benefited from concurrent chemoradiotherapy followed by adjuvant chemotherapy. [Copyright &y& Elsevier]

Abstract: Objectives: To elucidate the effect of primary tumor volume (PTV) on treatment outcomes in patients with nasopharyngeal carcinoma (NPC) who were treated with radiotherapy or concurrent chemoradiotherapy. The TNM staging system developed by American Joint Committee of Cancer (AJCC) is universally used and accepted but its prediction of prognosis in NPC receives a lot of challenge. Primary tumor volume had been reported to have close relationship with prognosis of head and neck cancer. We may predict prognosis of NPC with PTV. Methods: From 1999 to 2006, 91 patients with newly diagnosed NPC who were treated with radiotherapy or CCRT were enrolled in the study. Computed tomography-derived or magnetic resonance-derived primary tumor volume was calculated. The correlation between AJCC disease stage, primary tumor volume and disease-specific survival were analyzed. Multivariate analyses using the Cox proportional hazard model was performed. Results: The median primary tumor volume for the whole series was 11.39ml (range 1.25–166.58ml). The median primary tumor volume was 2.69ml in T1 disease, 10.14ml in T2 disease, 15.41ml in T3 disease, and 26.69ml in T4 disease. Hazard ratio increased with tumor volume, ranging from 5.91 (95% confidence interval (95% CI) 1.13–26.43) for tumor volumes between 20ml and 40ml, and 15.72 (95% CI, 3.82–61.05) for tumor volumes >40ml. With both tumor volume and T classification in the same Cox regression model, only tumor volume remained statistically significant in the prognosis of NPC. Conclusion: Primary tumor volume has closer relationship with survival rates of patients with NPC. Calculation of primary tumor volume may be further considered to improve the current staging system. [Copyright &y& Elsevier]

Background: Primary tumor volume (PTV) is known to be a significant prognostic factor in malignant tumor. There have been several studies of nasopharyngeal carcinoma (NPC) relating tumor volume to treatment outcome. Our study was designed to evaluate the effect of PTV on treatment outcomes in NPC treated with radiotherapy (RT)/concurrent chemoradiotherapy (CCRT) or CCRT with adjuvant chemotherapy. Methods: We retrospectively reviewed 100 cases with newly diagnosed NPC who were treated with RT/CCRT or CCRT with adjuvant chemotherapy from 2002 to 2006. Magnetic resonance imaging-derived PTV was calculated using the summation-of-area technique. Kaplan-Meier plots and the log-rank test were used to estimate tumor recurrence (locoregional, distant, or both) and overall survival. Cox proportional hazards regression analysis was used to assess the prognostic impact of PTV. Results: The median PTV was 12.94 mL. PTV remained an independent prognostic factor for distant metastasis (hazard ratio [HR], 1.04; p = 0.03), for any relapse (HR, 1.04; p = 0.02), and for overall survival (HR, 1.09; p < 0.001) in multivariate analysis. In the large tumor volume group (PTV > 15 mL), patients'' metastasis-free survival rates, with and without adjuvant chemotherapy, were 100% and 68.3%, respectively (p = 0.002). Their 3-year recurrence-free survival rates, with and without adjuvant chemotherapy, were 94.1% and 69.6%, respectively (p = 0.006). In the small tumor volume group (PTV £ 15 mL), this phenomenon was not observed. Conclusion: PTV had a close relationship with survival rates and recurrence rates in patients with NPC. The large tumor volume group (PTV > 15 mL) was associated with more recurrence and poor survival rate, and it was suggested that these high-risk patients should benefit from CCRT followed by adjuvant chemotherapy. [Copyright &y& Elsevier]

We conducted a retrospective study to evaluate the effect of primary tumor volume on treatment outcomes in patients with nasopharyngeal carcinoma (NPC) who were treated with radiotherapy (RT)/concurrent chemoradiotherapy (CCRT) or CCRT with adjuvant chemotherapy. A total of 106 patients with newly diagnosed NPC were enrolled in this study. Magnetic resonance imaging (MRI)-derived primary tumor volume [gross tumor volume of the primary and involved retropharyngeal nodes (GTV-P)] was calculated. All patients received a total dose of 70–75 Gy. Forty-three patients (40.6%) received CCRT and 28 patients (26.4%) received CCRT with adjuvant chemotherapy. The median of primary tumor volume was 13.8 ml. Using T stage as covariate, primary tumor volume remained an independent prognostic factor for distant metastasis [hazard ratio (HR) 1.036; P = 0.04), for any relapse (HR 1.03; P = 0.03) and overall survival (HR 1.08; P = 0.0001). In the large tumor volume group (GTV-P > 15 ml), the 3-year metastasis-free survival rate, with and without adjuvant chemotherapy, was 100 and 69.2%, respectively ( P = 0.014). Their 3-year recurrence-free survival rate, with and without adjuvant chemotherapy, was 94.7 and 66.7%, respectively ( P = 0.035). This phenomenon was not observed in NPC patients with small tumor volume (GTV-P ≤ 15 ml). Our findings suggested that the risk of recurrence in NPC patients with small tumor volume is low. NPC with large tumor volume is associated with more recurrence and poor survival rates. These high-risk patients should be the group to benefit from CCRT followed by adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Conclusions. Primary tumor volume (PTV) has a close relationship with survival rates of patients with nasopharyngeal carcinoma (NPC) who were treated with concurrent chemoradiotherapy (CCRT) or radiotherapy. Besides the current AJCC staging system, measurement of PTV may be needed to predict prognosis of NPC and adjust treatment strategy. Objectives. We conducted a retrospective study to elucidate the effect of PTV on treatment outcomes in patients with NPC who were treated with CCRT or radiotherapy. Patients and methods. A total of 66 patients with newly diagnosed NPC were enrolled in this study. Computed tomography (CT)-derived or magnetic resonance imaging (MRI)-derived PTV was calculated. The correlation between AJCC disease stage, PTV, and disease-specific survival was analyzed. Correlations between different prognostic factors were assessed using a Cox regression model. Results. The median PTV for the whole series was 12.01 ml (range 1.25-166.58 ml). The median PTV was 3.45 ml in T1 disease, 7.96 ml in T2 disease, 17.95 ml in T3 disease, and 64.73 ml in T4 disease. Disease stage and T stage carried no prognostic significance (p=0.25 and p=0.30, respectively). Four categories of PTV (<12.5 ml, 12.5-25 ml, 25-50 ml and >50 ml) had prognostic significance (p=0.02). Survival analysis demonstrated a significant difference in overall survival with larger tumor volume (risk ratio 5.447; p=0.044). [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship of p53 protein expression and primary tumour volume in patients with nasopharyngeal carcinoma. Design: Retrospective study. Setting: Tertiary care centre. Method: Forty-two newly diagnosed patients participated in the study. Main Outcome Measures: The relationship between p53 status, TNM stage, and computed tomography-derived primary tumour volume. Results: In patients with high p53 stains, the tumour volume was larger (p = .03). p53 was found to be independent of clinical stage (p = .84). Conclusion: There is a positive correlation between primary tumour volume and p53 status. [ABSTRACT FROM AUTHOR]

: PurposeTo study the prognostic significance of primary tumor volume on local control of nasopharyngeal carcinoma.: Methods and materialsBetween 1998 and 2001, 308 consecutive patients with nasopharyngeal carcinoma treated with radical intent were staged with MRI. On the basis of the extent of tumor infiltration outlined by a diagnostic radiologist, the gross tumor volume of the primary and involved retropharyngeal nodes (GTV-P) was delineated by a radiation oncologist for three-dimensional conformal radiotherapy to the nasopharyngeal region using the Helax-TMS Planning System. All patients were treated with 2 Gy daily to a total dose of 70 Gy in 6–7 weeks. Additionally, chemotherapy was given to 128 patients (42%).: ResultsThe median GTV-P for the whole series was 22 cm3 (range, 1.4–218 cm3). Although the GTV-P varied substantially within each T stage, the overall correlation between these two parameters was strongly significant (p <0.01), with the median GTV-P 2.7 cm3 for T1, 13.2 cm3 for T2, 28.1 cm3 for T3, and 65.5 cm3 for T4. With a median follow-up of 1.9 years (range, 0.1–3.9 years), the 3-year local failure-free rate was 87%. The 3-year local failure-free rate was 97% for patients with a GTV-P <15 cm3 compared with 82% for those with a GTV-P ≥15 cm3 (p <0.01). On multivariate analysis (with T stage as a covariate), GTV-P remained an independent prognostic factor for the local failure-free rate (hazard ratio, 1.01; 95% confidence interval, 1.00–1.02; p <0.01).: ConclusionOur data suggested that GTV-P is a strongly significant factor for predicting local control of nasopharyngeal carcinoma. The risk of local failure was estimated to increase by 1% for every 1 cm3 increase in primary tumor volume. [Copyright &y& Elsevier]