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Войти в исследования Translational cancer research · 2026
Adaptive radiotherapy based on nodal response to induction chemotherapy in nasopharyngeal carcinoma: a retrospective dose de-escalation analysis.
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Huang Wenxuan, Wang Weisi, Ge Yizhi, Zong Dan, Zhang Lanfang, Wang Lijun, Huang Shengfu, He Xia
Аннотация
BACKGROUND: Induction chemotherapy (IC) substantially reduces tumor burden in locoregionally advanced nasopharyngeal carcinoma (LA-NPC), enabling radiotherapy target volume optimization based on post-IC tumor volume. However, most existing studies have focused on the primary tumor, with limited attention to cervical nodal targets. This study aimed to evaluate the long-term efficacy and safety of response-adapted nodal dose de-escalation in patients achieving complete nodal response after IC without high-risk features.
METHODS: A retrospective analysis was conducted on 214 patients with stage II-IVA NPC treated with IC followed by intensity-modulated radiotherapy (IMRT) between June 2018 and December 2020. Patients with complete nodal response post-IC and no high-risk features-defined as necrosis, extranodal extension, nodal size ≥3 cm, or multiple nodes within a single drainage level-were selected for dose de-escalation (50-64 Gy) to the nodal gross tumor volume (GTVnd) and the corresponding clinical target volume (CTV). Treatment outcomes, Epstein-Barr virus (EBV) DNA kinetics, dosimetric parameters, and toxicities were systematically analyzed.
RESULTS: The complete nodal response rate post-IC was 33.6% (72/214). A total of 60 patients (28.0%) who achieved complete response without high-risk features met the criteria for nodal dose de-escalation. After a median follow-up of 45.0 months, no nodal recurrences were observed within de-escalated regions. The 3-year progression-free survival (PFS), overall survival (OS), and locoregional relapse-free survival (LRRFS) rates were 91.7%, 96.7%, and 100%, respectively. Dose de-escalation significantly reduced radiation exposure to salivary glands and was associated with a low incidence of late xerostomia.Patients with complete response demonstrated significantly higher EBV DNA clearance rates post-IC (80.6% vs. 56.3%) and improved survival outcomes.
CONCLUSIONS: For LA-NPC patients achieving nodal complete response after IC and without high-risk features, tailored dose reduction to nodal GTV and CTV achieved excellent locoregional control with reduced long-term toxicity.
METHODS: A retrospective analysis was conducted on 214 patients with stage II-IVA NPC treated with IC followed by intensity-modulated radiotherapy (IMRT) between June 2018 and December 2020. Patients with complete nodal response post-IC and no high-risk features-defined as necrosis, extranodal extension, nodal size ≥3 cm, or multiple nodes within a single drainage level-were selected for dose de-escalation (50-64 Gy) to the nodal gross tumor volume (GTVnd) and the corresponding clinical target volume (CTV). Treatment outcomes, Epstein-Barr virus (EBV) DNA kinetics, dosimetric parameters, and toxicities were systematically analyzed.
RESULTS: The complete nodal response rate post-IC was 33.6% (72/214). A total of 60 patients (28.0%) who achieved complete response without high-risk features met the criteria for nodal dose de-escalation. After a median follow-up of 45.0 months, no nodal recurrences were observed within de-escalated regions. The 3-year progression-free survival (PFS), overall survival (OS), and locoregional relapse-free survival (LRRFS) rates were 91.7%, 96.7%, and 100%, respectively. Dose de-escalation significantly reduced radiation exposure to salivary glands and was associated with a low incidence of late xerostomia.Patients with complete response demonstrated significantly higher EBV DNA clearance rates post-IC (80.6% vs. 56.3%) and improved survival outcomes.
CONCLUSIONS: For LA-NPC patients achieving nodal complete response after IC and without high-risk features, tailored dose reduction to nodal GTV and CTV achieved excellent locoregional control with reduced long-term toxicity.