Practical radiation oncology · 2026
Overlap-Adapted Subvolume Prescription to Reduce Temporal Lobe Injury Risk in T4 Nasopharyngeal Carcinoma: A Prospective Cohort Study With a Contemporaneous Comparator.
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Liao Huadong, Wang Jing, Lai Yongzheng, Ding Peng, Su Yong, Dong Qing, Hu Liping, Liu Lan, Gao Xiying, Xie Honghui, Xiao Yun, Zeng Lei, Lu Tianzhu, Gong Xiaochang, Li Jingao
Аннотация
PURPOSE: Radiation-induced temporal lobe injury (RTLI) remains a major late toxicity in T4 nasopharyngeal carcinoma (NPC) because primary target volumes frequently overlap the temporal lobe planning risk volume, limiting near-maximum dose constraints. This study evaluated the long-term safety and efficacy of an overlap-adapted subvolume prescription strategy.
METHODS AND MATERIALS: This nonrandomized, single-institution, prospective observational cohort study with a contemporaneous comparator (ClinicalTrials.gov identifier: NCT03539250) enrolled patients with T4N0-3M0 NPC treated between 2018 and 2022 who had planning target volume (PTV)-temporal lobe planning risk volume overlap ≥0.1 cm3. The modified delineation and planning (MD) approach subdivided the primary tumor PTV (PTVnx) into a nonoverlap subvolume (PTVsv1, prescribed 70 Gy) and an overlapping subvolume (PTVsv2, prescribed 66 Gy) using simultaneous integrated boost. The standard delineation and planning (SD) approach prescribed a uniform 70 Gy to the entire PTVnx.
RESULTS: Among 361 patients (MD, n = 104; standard delineation and planning, n = 257), the 5-year cumulative incidence of RTLI was significantly lower in the MD group (23.2% vs 36.2%; P = .019). Multivariable analysis revealed that MD was independently associated with reduced RTLI risk (hazard ratio, 0.56; 95% CI, 0.34-0.94; P = .029). No significant differences were found in 5-year local relapse-free survival (92.3% vs 89.6%; P = .577) or overall survival (84.7% vs 84.4%; P = .896). No marginal recurrences were confined to PTVsv2. After lobe-level propensity-score matching (205 lobes per group), MD achieved significantly lower temporal-lobe maximum dose and dose to 1 cm3 (both P < .001) without differences in volumes receiving 40 to 60 Gy and a borderline reduction in volume receiving ≥65 Gy (P = .053).
CONCLUSIONS: An overlap-adapted subvolume prescription strategy (66 Gy to PTVsv2) significantly reduced the incidence of radiographic RTLI while preserving long-term tumor control in anatomically constrained T4 NPC. The reduction in symptomatic RTLI was numerical but did not reach statistical significance and warrants further validation.
METHODS AND MATERIALS: This nonrandomized, single-institution, prospective observational cohort study with a contemporaneous comparator (ClinicalTrials.gov identifier: NCT03539250) enrolled patients with T4N0-3M0 NPC treated between 2018 and 2022 who had planning target volume (PTV)-temporal lobe planning risk volume overlap ≥0.1 cm3. The modified delineation and planning (MD) approach subdivided the primary tumor PTV (PTVnx) into a nonoverlap subvolume (PTVsv1, prescribed 70 Gy) and an overlapping subvolume (PTVsv2, prescribed 66 Gy) using simultaneous integrated boost. The standard delineation and planning (SD) approach prescribed a uniform 70 Gy to the entire PTVnx.
RESULTS: Among 361 patients (MD, n = 104; standard delineation and planning, n = 257), the 5-year cumulative incidence of RTLI was significantly lower in the MD group (23.2% vs 36.2%; P = .019). Multivariable analysis revealed that MD was independently associated with reduced RTLI risk (hazard ratio, 0.56; 95% CI, 0.34-0.94; P = .029). No significant differences were found in 5-year local relapse-free survival (92.3% vs 89.6%; P = .577) or overall survival (84.7% vs 84.4%; P = .896). No marginal recurrences were confined to PTVsv2. After lobe-level propensity-score matching (205 lobes per group), MD achieved significantly lower temporal-lobe maximum dose and dose to 1 cm3 (both P < .001) without differences in volumes receiving 40 to 60 Gy and a borderline reduction in volume receiving ≥65 Gy (P = .053).
CONCLUSIONS: An overlap-adapted subvolume prescription strategy (66 Gy to PTVsv2) significantly reduced the incidence of radiographic RTLI while preserving long-term tumor control in anatomically constrained T4 NPC. The reduction in symptomatic RTLI was numerical but did not reach statistical significance and warrants further validation.