Radiation, Chemotherapy, and Bevacizumab Guidelines
primary disease, tumor, necrotic
DISEASE, TUMOR, CAVITY, NECROTIC
For radiation planning, fusion of MRI or PET/CT scans with treatment-planning CT images was encouraged to accurately define the gross tumor volume, which consisted of the primary disease in the nasopharynx and nodes greater than 1 cm in diameter or nodes with necrotic centers. Areas at risk for subclinical spread of disease included the entire nasopharynx, retropharyngeal nodal regions, clivus, skull base, pterygoid fossae parapharyngeal fat (coverage of trigeminal nerve V3), sphenoid sinus, and posterior third of the nasal cavity or maxillary sinuses, including the pterygopalatine fossae (coverage of trigeminal nerve V2) and bilateral neck I through V lymph nodal regions. Level I nodal regions were not included in the N0 neck. IMRT was delivered in 33 fractions using a simultaneous integrated boost technique in which the planning target volume (PTV) of the gross disease received radiation doses as follows: PTVBevacizumab (15 mg/kg) was given concurrently with cisplatin (100 mg/m