Reirradiation based on diffusion-weighted magnetic resonance imaging-guided dose-painting for locally advanced recurrent nasopharyngeal carcinoma: a phase 2 randomized controlled trial
Mené sur 150 patients atteints d'un carcinome rhinopharyngé localement avancé et récidivant (durée médiane de suivi : 16 mois), cet essai randomisé de phase II évalue l'efficacité, du point de vue de la survie sans progression et de la survie sans récidive locale, d'une radiothérapie avec modulation d'intensité et "dose-painting" guidée par IRM de diffusion par rapport à une radiothérapie avec modulation d'intensité conventionnelle guidée par IRM
Introduction: The effect of diffusion-weighted magnetic resonance imaging (DWI)-guided dose-painting intensity-modulated radiation therapy (DP-IMRT) on locally advanced recurrent nasopharyngeal carcinoma (NPC) remains unclear. This study aimed to compare the outcomes and toxicities of DWI-guided DP-IMRT in patients with locally recurrent NPC.
Methods: In this prospective trial, 150 patients with locally advanced recurrent NPC were randomly assigned (1:1) to receive reirradiation with DWI-guided DP-IMRT (DWI group, n = 75) or conventional MRI-based IMRT (MRI group, n = 75). In the DWI group, DWI-guided gross tumor volume received escalation to 65.4 Gy/30 fx in 2.18 Gy per fraction, while in the MRI group, the planning target volume was irradiated at 60 Gy/30fx in 2.0 Gy per fraction. The trial was registered at Chictr.org.cn (ChiCTR2100052340) on October 24, 2021. Survival rates were compared, and multivariate analyses were conducted.
Results: The median follow-up duration was 16 months. Compared with the MRI group, patients in the DWI group had better 18-month progression-free survival (PFS) 75.1% vs. 53.6%; P = 0.006), local recurrence-free survival (LRFS) (83.4% vs. 61.8%; P = 0.010), and locoregional recurrence-free survival (73.1% vs. 64.9%; P = 0.025). Grade 3–4 toxicities between the two groups showed no significant difference. Multivariate analysis revealed that DWI-guided DP-IMRT was an independent prognostic factor for PFS and LRFS.
Conclusion: Compared with conventional MRI-based IMRT, DWI-guided DP-IMRT improved PFS in patients with recurrent NPC without increasing acute and late toxic effects.
BMC Cancer , article en libre accès 2025