{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:17:27Z","timestamp":1787753847352,"version":"build-2784847793"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Med Oncol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Residual locoregionally advanced nasopharyngeal carcinoma (LA-NPC) after definitive chemoradiation leads to poor outcomes, but current treatments lack standardized, evidence-based guidance for individualized dose escalation, causing varied practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop a risk-stratification model to personalize boost doses for these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, 364 LA-NPC patients with post-radiotherapy (post-RT) residual disease were enrolled. Patients were stratified into high-dose (\u2265600 cGy, n=201) and low-dose (&lt;600 cGy, n=163) boost groups. Independent prognostic factors were identified via Cox regression. A risk stratification model was constructed using these factors, and its utility in guiding boost dose selection was evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multivariate analysis confirmed that clinical stage (HR=2.012, 95% CI: 1.100-3.682, p=0.023) and detectable post-RT EBV DNA (HR=1.997, 95% CI: 1.129-3.535, p=0.018) were independent prognostic factors for LA-NPC patients with residual disease after definitive chemoradiotherapy. Based on these variables, a three-tiered risk model was established: low-risk (Stage III with undetectable post-RT EBV DNA), middle-risk (Stage III with detectable post-RT EBV DNA or Stage IVA with undetectable post-RT EBV DNA), and high-risk (Stage IVA with detectable post-RT EBV DNA). This model effectively stratified patients for overall survival (OS) (P&lt;0.05). Crucially, a high-dose boost (\u2265600 cGy) was associated with improved OS in the high-risk group (HR=0.344, 95% CI: 0.122\u20130.967, P=0.043), whereas no survival advantage was identified in the low- or middle-risk groups. Among high-risk patients, no statistically significant differences in acute or late toxicities were observed between the high-dose and low-dose boost groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We developed a clinically applicable risk stratification model integrating clinical stage and post-RT EBV DNA status. Our findings suggest that only high-risk patients may derive an OS benefit from a boost dose of \u2265600 cGy, whereas low- and middle-risk patients do not appear to benefit from further dose escalation. This risk-adapted boost strategy provides a preliminary framework requiring prospective validation. Given the retrospective single-center design of this study, prospective multicenter studies are warranted before routine clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17588359261483547","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:28:09Z","timestamp":1787588889000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk stratification and boost dose optimization for locoregionally advanced nasopharyngeal carcinoma with residual lesions based on clinical stage and post-radiotherapy EBV DNA"],"prefix":"10.1177","volume":"18","author":[{"given":"Xinyi","family":"Hong","sequence":"first","affiliation":[{"name":"Clinical Oncology School of Fujian Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Clinical Oncology School of Fujian 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