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The planning target volume (PTV) received a median total dose of 57.6\u00a0Gy (1.8\u00a0Gy\/fraction) with a simultaneous integrated boost to the primary tumor and nodal metastases up to 70.4\u00a0Gy. To assess recurrence patterns, follow-up imaging was deformably co-registered with planning CTs (pCT), and recurrent gross tumor volumes (rGTVs) were delineated and mapped to pCTs. Recurrences were categorized using a centroid-based system into five types: A (central high-dose), B (peripheral high-dose), C (central intermediate-\/low-dose), D (peripheral intermediate-\/low-dose), and E (extraneous dose).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>With a median follow-up of 73 months (range 24\u2013156), 9 patients (19%) had died. The 3-, 5-, and 10-year overall survival rates were 98%, 96%, and 67%, respectively. Local control rates (LCR) at 2, 3, and 5 years were 92%, 89%, and 89%; regional control was 96%, 94%, and 94%; and distant control was 92%, 89%, and 89%. Treatment was well tolerated, with no grade\u2009\u2265\u20094 toxicities. Grade 3 acute toxicities occurred in 23 patients (48%), most commonly dysphagia, with nearly all resolving within 90 days. Among treatment failures, distant metastases (13%) and local relapses (10%) were most frequent. Of 8 local and\/or regional recurrences analyzed, 2 were type A (central high-dose), 3 type B (\u201cmarginal\u201d), 2 type C (central intermediate-\/low-dose), and 1 type E (\u201cout-of-field\u201d).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IMRT with weekly cisplatin yields excellent survival and locoregional control with acceptable toxicity in NPC. Distant metastasis as one of the predominant failure patterns highlights the need for more effective systemic therapies. Most local recurrences arose within high-dose areas, suggesting a potential opportunity for treatment optimization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13014-025-02769-7","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T17:32:32Z","timestamp":1765215152000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Outcomes and recurrence pattern analysis of intensity modulated chemoradiotherapy in nasopharyngeal cancer: a retrospective study from Heidelberg University Hospital"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7711-934X","authenticated-orcid":false,"given":"Lukas","family":"Bauer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Regnery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian Y.","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Stritzke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schr\u00f6ter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Franke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils B.","family":"Netzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Uzun-Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Weusthof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubens","family":"Thoelken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Debus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Held","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"2769_CR1","unstructured":"International Agency for Research on Cancer (IARC). 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Institutional ethics board approval was waived by the medical ethical committee of University Hospital Heidelberg. Written informed consent was obtained from all individual participants included in the study. The privacy rights of all subjects have been strictly observed. Patient data were anonymized to protect confidentiality.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"183"}}