title: Patterns of local-regional failure after primary intensity modulated radiotherapy for nasopharyngeal carcinoma.
abstract: BACKGROUND
  To analyze patterns of local-regional failure after primary intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  A total of 370 non-metastatic NPC patients consecutively treated with IMRT (with or without chemotherapy) were analyzed. Radiotherapy was administered using a simultaneous integrated boost (SIB) technique at the total prescribed dose of 66-70.4 Gy (2.0-2.2 Gy per fraction). The location and extent of local-regional failures were transferred to the pretreatment planning computed tomography (CT) for dosimetric analysis. The dose of radiation received by V(recur) (volume of recurrence) was calculated and analyzed with dose-volume histogram (DVH). Failures were classified as: "in field" if 95% of V(recur) was within the 95% isodose, "marginal" if 20% to 95% of V(recur) was within the 95% isodose, or "outside" if less than 20% of V(recur) was inside the 95% isodose.
  
  
  RESULTS
  With a median follow up of 26 months, 25 local-regional failures were found in 18 patients. The 1- and 2-year actuarial local-regional control rates for all patients were 99.7% and 95.5% respectively. Among the 22 local-regional failures with available diagnostic images, 16 (64%) occurred within the 95% isodose lines and were considered in-field failures; 3 (12%) were marginal and 3 (12%) were outside-field failures.
  
  
  CONCLUSIONS
  Intensity-modulated radiotherapy provides excellent local-regional control for NPC. In-field failures are the main patterns for local-regional recurrence. Reducing the coverage of critical adjacent tissues in CTV purposefully for potential subclinical diseases was worth of study. Great attention in all IMRT steps is necessary to reduce potential causes of marginal failures. More studies about radioresistance are needed to reduce in-field failures.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Kong
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai 200032, P,R China. yinghongmei2013@163.com.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Ying
authors.forename: Chengrun
authors.initials: C
authors.lastname: Du
authors.forename: Shuang
authors.initials: S
authors.lastname: Huang
authors.forename: Junjun
authors.initials: J
authors.lastname: Zhou
authors.forename: Junchao
authors.initials: J
authors.lastname: Chen
authors.forename: Lining
authors.initials: L
authors.lastname: Sun
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Chen
authors.forename: Chaosu
authors.initials: C
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy*; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D050397:Radiotherapy, Intensity-Modulated; D017211:Treatment Failure; D047368:Tumor Burden; D055815:Young Adult