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Introduction <p>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.</p> Methods <p>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, <i>n</i> = 75) or conventional MRI-based IMRT (MRI group, <i>n</i> = 75). In the DWI group, DWI-guided gross tumor volume received escalation to 65.4&#xa0;Gy/30 fx in 2.18&#xa0;Gy per fraction, while in the MRI group, the planning target volume was irradiated at 60&#xa0;Gy/30fx in 2.0&#xa0;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.</p> Results <p>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%; <i>P</i> = 0.006), local recurrence-free survival (LRFS) (83.4% vs. 61.8%; <i>P</i> = 0.010), and locoregional recurrence-free survival (73.1% vs. 64.9%; <i>P</i> = 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.</p> Conclusion <p>Compared with conventional MRI-based IMRT, DWI-guided DP-IMRT improved PFS in patients with recurrent NPC without increasing acute and late toxic effects.</p>

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Reirradiation based on diffusion-weighted magnetic resonance imaging-guided dose- painting for locally advanced recurrent nasopharyngeal carcinoma: a phase 2 randomized controlled trial

  • 期刊论文

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  • 发表日期：

    2025年4月7日

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  • Chao Tan,
  • Yuyi Li,
  • Xiaoyu Chen,
  • Weichang Zhu,
  • Cuihong Jiang,
  • Lili He,
  • Shuai Xiao,
  • Changgen Fan,
  • Xu Ye,
  • Qi Zhao,
  • Wenqiong Wu,
  • Yanxian Li,
  • Yanfang Qiu,
  • Kailin Chen,
  • Shulu Hu,
  • Feng Liu,
  • Hui Wang

摘要

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.