title: Clinical application of tumor volume in advanced nasopharyngeal carcinoma to predict outcome.
abstract: BACKGROUND
  Current staging systems have limited ability to adjust optimal therapy in advanced nasopharyngeal carcinoma (NPC). This study aimed to delineate the correlation between tumor volume, treatment outcome and chemotherapy cycles in advanced NPC.
  
  
  METHODS
  A retrospective review of 110 patients with stage III-IV NPC was performed. All patients were treated first with neoadjuvant chemotherapy, then concurrent chemoradiation, and followed by adjuvant chemotherapy as being the definitive therapy. Gross tumor volume of primary tumor plus retropharyngeal nodes (GTVprn) was calculated to be an index of treatment outcome.
  
  
  RESULTS
  GTVprn had a close relationship with survival and recurrence in advanced NPC. Large GTVprn (> or =13 ml) was associated with a significantly poorer local control, lower distant metastasis-free rate, and poorer survival. In patients with GTVprn > or =13 ml, overall survival was better after > or =4 cycles of chemotherapy than after less than 4 cycles.
  
  
  CONCLUSIONS
  The incorporation of GTVprn can provide more information to adjust treatment strategy.
authors.affiliation: Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan 62247.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
authors.forename: Tze-Ta
authors.initials: TT
authors.lastname: Huang
authors.forename: Moon-Sing
authors.initials: MS
authors.lastname: Lee
authors.forename: Shih-Hsuan
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Su
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Hsu
authors.forename: Shih-Kai
authors.initials: SK
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D016016:Proportional Hazards Models; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects