{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:14Z","timestamp":1783318514543,"version":"3.54.6"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>For locally advanced nasopharyngeal carcinoma (NPC) with tumor close to the cervical spinal cord, strict spinal cord constraints may compromise target coverage. We evaluated the feasibility and safety of a target-prioritized IMRT strategy in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 909 consecutive patients with stage III\u2014IVB NPC treated with IMRT between 2012 and 2022. Among 145 patients with tumour-cord proximity, 106 (73.1%) received a target-prioritized strategy, when adequate target coverage could not be achieved under conventional constraints. Dosimetric parameters were extracted from dose-volume histograms. Predictors were evaluated by logistic regression and a cumulative cranio-cervical burden score. Outcomes were analyzed using Kaplan-Meier and log-rank test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>With a median follow-up of 76.11 months, no clinically diagnosed radiation myelopathy (RM) was observed in the overall cohort (upper one-sided 95% CI, 0.33%). The 5-year local relapse\u2013free survival (LRFS) and overall survival (OS) were 92.8% and 86.8%. The cumulative burden score, based on occipital base, occipital condyle, and atlanto-dental interval involvement, was associated with target-prioritized planning (trend OR, 1.906; P\u00a0=\u00a00.001). In the target-prioritized cohort, median cord Dmax was 56.2 Gy, and 22 patients (20.8%) had a Dmax &amp;gt;60 Gy, while high-dose volumes remained limited. With a median follow-up of 93.24 months in this cohort, 5-year LRFS and OS rates were 87.9% and 74.2%, respectively, and no clinically diagnosed RM was observed (upper one-sided 95% CI, 2.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With strict dose-volume control and image guidance, target-prioritized strategy appears feasible in selected NPC cases but does not support modification of current spinal cord constraints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1878456","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:37:35Z","timestamp":1783316255000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Target-prioritized IMRT for nasopharyngeal carcinoma with tumor proximity to the spinal cord: clinical feasibility and long-term outcomes"],"prefix":"10.3389","volume":"16","author":[{"given":"Yang","family":"Li","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxuan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Changshu Hospital Affiliated to Soochow University, Changshu No. 1 People\u2019s Hospital","place":["Changshu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengfu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"He","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lirong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2024.101594","article-title":"Enhancing efficacy and reducing toxicity: Therapeutic optimization in locoregionally advanced nasopharyngeal 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