Retrospective Study on the Prediction of Radiation-induced Brain Injury in Patients With Nasopharyngeal Carcinoma
Condition: Nasopharyngeal Carcinoma; Radiation-Induced Temporal Lobe Injury
MeSH terms: Carcinoma; Nasopharyngeal Carcinoma
Study type: Observational

Summary: 
      Radiation therapy has become the preferred treatment for nasopharyngeal cancer due to the
      sensitivity of nasopharyngeal carcinoma to radiation. However, even with the use of
      intensity-modulated radiation therapy (IMRT), radiation-induced temporal lobe injury (RTLI)
      can be a severe complication. Patients with RTLI may experience long-term memory loss,
      personality changes, physical dysfunctions, and other symptoms, which seriously impair their
      quality of life and long-term prognosis. Currently, the diagnosis of RTLI primarily relies on
      clinical symptoms and imaging examinations such as computed tomography (CT) and conventional
      MRI. However, these methods only enable the diagnosis of RTLI at a late stage when it is
      irreversible and cannot be effectively treated. Therefore, the early identification or
      individualized prediction of RTLI after IMRT holds exceptional importance for improving the
      quality of life in nasopharyngeal carcinoma patients.

      The exact mechanism of RTLI remains unclear. Many clinical covariates have been proven to be
      associated with RTLI in NPC patients, including stage, age, and dosimetric parameters. In
      addition, it was reported that each patient's temporal lobe exhibits unique genetic
      susceptibility to radiation exposure. In this study, we aim to predict the occurrence of RTLI
      by analyzing clinical factors and heterogeneity of temporal lobe tissue prior to irradiation.
      Finally, we want to construct and validate a prediction model for RLTI, which can support
      clinician decision-making in developing individualized treatment plans and providing
      preventive measures.
    


Intervention name(s): intensity-modulated radiotherapy
Intervention type(s): Radiation
Intervention description(s): All patients were staged according to the 8th edition of the TNM classification by the American Joint Committee on Cancer/Union for International Cancer Control and received a standardized treatment regimen including IMRT and concurrent or adjuvant chemotherapy. Inverse IMRT treatment planning was performed on a Varian Inspiration Platform (version 10.0), using the simultaneous integrated boost technique. The prescribed doses were 68-75 Gy to the PTV of the GTVnx in 32-34 fractions; 64-75 Gy to the PTV of the GTVnd in 32-34 fractions; 60 Gy to the PTV of CTV1 in 32 fractions; and 50 Gy to the PTV of CTV2 in 28 fractions. All patients were given one fraction daily 5 days a week. The dose-volume-histograms (DVHs) of the organs at risk were evaluated as described in the radiation therapy oncology group (RTOG) 0225 protocol to prevent violation of the tolerance limits.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        nasopharyngeal carcinoma paients who recieved intensity-modulated radiotherapy
      
Keywords: radiomics; machine learning; deep learning