{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:10:35Z","timestamp":1791807035445,"version":"4.3.4"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T00:00:00Z","timestamp":1645574400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82002428"],"award-info":[{"award-number":["82002428"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81902762"],"award-info":[{"award-number":["81902762"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["2019014"],"award-info":[{"award-number":["2019014"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["2021A1515010853"],"award-info":[{"award-number":["2021A1515010853"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002402","name":"Sun Yat-sen University","doi-asserted-by":"publisher","award":["82002428"],"award-info":[{"award-number":["82002428"]}],"id":[{"id":"10.13039\/501100002402","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002402","name":"Sun Yat-sen University","doi-asserted-by":"publisher","award":["81902762"],"award-info":[{"award-number":["81902762"]}],"id":[{"id":"10.13039\/501100002402","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002402","name":"Sun Yat-sen University","doi-asserted-by":"publisher","award":["2019014"],"award-info":[{"award-number":["2019014"]}],"id":[{"id":"10.13039\/501100002402","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002402","name":"Sun Yat-sen University","doi-asserted-by":"publisher","award":["2021A1515010853"],"award-info":[{"award-number":["2021A1515010853"]}],"id":[{"id":"10.13039\/501100002402","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["82002428"],"award-info":[{"award-number":["82002428"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["81902762"],"award-info":[{"award-number":["81902762"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2019014"],"award-info":[{"award-number":["2019014"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2021A1515010853"],"award-info":[{"award-number":["2021A1515010853"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Oncology"],"published-print":{"date-parts":[[2022,2,23]]},"abstract":"<jats:p>Purpose. To quantify the long-term evaluation of optic chiasma (OC) and\/or optic nerve(s) (ONs) and to develop predictive models for radiation-induced optic neuropathy (RION) in nasopharyngeal carcinoma after intensity-modulated radiotherapy (IMRT). Methods and Materials. A total of 3,662 patients\u2019 OC\/ONs with full visual acuity and dosimetry data between 2010 and 2015 were identified. Critical dosimetry predictors of RION were chosen by machine learning and penalized regression for survival. A nomogram containing dosimetry and clinical variables was generated for predicting RION-free survival. Results. The median follow-up was 71.79 (2.63\u2013120.9) months. Sixty-six eyes in 51 patients (1.39%) developed RION. Two patients were visual field deficient, and 49 patients had visual acuity of less than 0.1 (20\/200). The median latency time was 36 (3\u201390) months. The 3-, 5-, and 8-year cumulative incidence of RION was 0.78%, 1.19%, and 1.97%, respectively. Dmax was the most critical dosimetry variable for RION (AUC: 0.9434, the optimal cutoff: 64.48\u2009Gy). Patients with a Dmax \u226564.48\u2009Gy had a significantly higher risk of RION (HR\u2009=\u2009102.25; 95%CI, 24.86\u2013420.59; <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>P<\/a:mi>\n                        <a:mo>&lt;<\/a:mo>\n                        <a:mn>0.001<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>). Age (&gt;44\u2009years) (HR\u2009=\u20092.234, 95% CI\u2009=\u20091.233\u20134.051, p\u2009=\u20090.008), advanced T stage (T3 vs. T1-2: HR\u2009=\u20097.516, 95% CI\u2009=\u20091.725\u201332.767, <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>0.007<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>; T4 vs. T1-2: HR\u2009=\u200937.189, 95% CI\u2009=\u20098.796\u2013157.266, <jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>P<\/e:mi>\n                        <e:mo>&lt;<\/e:mo>\n                        <e:mn>0.001<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>), and tumor infiltration\/compression of the OC\/ONs (HR\u2009=\u20094.572, 95% CI\u2009=\u20091.316\u201315.874, <jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mi>p<\/g:mi>\n                        <g:mo>=<\/g:mo>\n                        <g:mn>0.017<\/g:mn>\n                     <\/g:math>\n                  <\/jats:inline-formula>) were significant clinical risk factors of RION. A nomogram comprising age, T stage, tumor infiltration\/compression of the OC\/ON, and Dmax significantly outperformed the model, with only Dmax predicting RION (C-index: 0.916 vs. 0.880, <jats:inline-formula>\n                     <i:math xmlns:i=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\">\n                        <i:mi>P<\/i:mi>\n                        <i:mo>&lt;<\/i:mo>\n                        <i:mn>0.001<\/i:mn>\n                     <\/i:math>\n                  <\/jats:inline-formula> in the training set; 0.899 vs. 0.874, <jats:inline-formula>\n                     <k:math xmlns:k=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\">\n                        <k:mi>P<\/k:mi>\n                        <k:mo>=<\/k:mo>\n                        <k:mn>0.038<\/k:mn>\n                     <\/k:math>\n                  <\/jats:inline-formula> in the test set). The nomogram-defined high-risk group had a worse 8-year RION-free survival. Conclusions. In the IMRT era, Dmax &lt;60\u2009Gy is safe and represents an acceptable dose constraint for most NPC patients receiving IMRT. A reasonable trade-off for selected patients with unsatisfactory tumor coverage due to proximity to the optic apparatus would be Dmax &lt;65\u2009Gy. Caution should be exercised when treating elderly and advanced T-stage patients or those with tumor infiltration\/compression of the OC\/ON. Our nomogram shows strong efficacy in predicting RION.<\/jats:p>","DOI":"10.1155\/2022\/3647462","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T17:50:09Z","timestamp":1645638609000},"page":"1-10","source":"Crossref","is-referenced-by-count":4,"title":["Long-Term Evaluation and Normal Tissue Complication Probability (NTCP) Models for Predicting Radiation-Induced Optic Neuropathy after Intensity-Modulated Radiation Therapy (IMRT) for Nasopharyngeal Carcinoma: A Large Retrospective Study in China"],"prefix":"10.1155","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0332-736X","authenticated-orcid":true,"given":"Yan-Ling","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology, South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7605-3609","authenticated-orcid":true,"given":"Wen-Fei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology, South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5517-1478","authenticated-orcid":true,"given":"Kai-Bin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology, South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2478-4543","authenticated-orcid":true,"given":"Lei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology, South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2329-3593","authenticated-orcid":true,"given":"Jing-Rong","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Data Mining and Analysis, Guangzhou Tianpeng Technology Co. Ltd., Zhujiang East Rd. No. 11, Guangzhou 510627, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4998-8502","authenticated-orcid":true,"given":"Fo-Ping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology, South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Dan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology, South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, 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