Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: Experience of 370 consecutive cases

Abstract

IntroductionTo investigate the outcome of locoregionally advanced nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT) after induction chemotherapy, with or without concomitant chemotherapy.MethodsBetween August 2003 and March 2007, 370 patients with locoregionally advanced NPC were treated with IMRT. Presenting stages were stage IIB in 62, stage III in 197, and stage IVA/B in 111 patients. All patients except for 36 patients with cervical lymphadenopathy of 4 cm or less in diameter received 2 cycles of cisplatin-based neoadjuvant chemotherapy. Forty-eight patients received cisplatin-based concurrent chemotherapy as well.ResultsWith a median follow-up time of 31 months (range 5 to 61 months), the 3-year local control, regional control, metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS) rates were 95%, 97%, 86%, 81% and 89%, respectively. Multivariate analyses revealed that both age (≤ 60 vs. >60) and N-classification are significant prognosticators for OS (P = 0.001, hazard ratio [HR] 2.395, 95% confidence interval [CI] 1.432-4.003; P = 0.012, hazard ratio [HR] 2.614, 95% confidence interval [CI] 1.235-5.533); And N-classification is the only significant predicative factor for MFS (P = 0.002, [HR] 1.99, 95% CI 1.279-3.098). T-classification and concurrent chemotherapy were not significant prognostic factors for local/regional control, MFS, DFS, or OS. Subgroup analysis revealed that concurrent chemotherapy provided no significant benefit to IMRT in locoregionally advanced NPC, but was responsible for higher rates of grade 3 or 4 acute toxicities (50% vs. 29.8%, P < 0.005). No grade 3 or 4 late toxicity including xerostomia was observed. However, two patients treated with IMRT and neoadjuvant but without concurrent and adjuvant chemotherapy died of treatment related complications.ConclusionIMRT following neoadjuvant chemotherapy produced a superb outcome in terms of local control, regional control, MFS, DFS, and OS rates in patients with stage IIB to IVB NPC. Effective treatment strategy is urgently needed for distant control in patients diagnosed with locoregionally advanced NPC.

Alternative endpoints to the 5-year overall survival and locoregional control for nasopharyngeal carcinoma: A retrospective analysis of 2,450 patients

“…However, a number of those studies only calculated OS and LRC within a 2-to 4-year follow-up period (9,11,12,(25)(26)(27)(28)(30)(31)(32), giving rise to the question whether these OS and LRC rates were the same as the 5-year OS and LRC rates. The results of our study indicated that the rates were indeed comparable.…”

Locally advanced nasopharyngeal carcinoma: Current and emerging treatment strategies

“…With a median follow-up of 31 mo, the three-year disease-free-survival and overall survival were 81% and 89%, respectively. A subgroup analysis revealed that concurrent chemotherapy provided no significant benefit to IMRT but was responsible for higher rates of grade 3/4 toxicities [35] . A recent Italian phase Ⅱ trial carried out by Palazzi et al [36] enrolled 87 patients with locally advanced NPC and treated them with either conventional RT or with IMRT.…”

“…In the last three years, a significant effort has been made to incorporate IMRT in treatment protocols for locally advanced NPC. In a phase Ⅱ study, Lin et al [35] treated a total of 370 patients with locally advanced NPC, with stages ranging from Ⅱb to Ⅳ, with induction cisplatin-based chemotherapy followed by exclusive IMRT or the association of IMRT and concomitant cisplatin. Drugs more frequently used in combination with cisplatin were paclitaxel and 5-fluorouracil.…”

Prognostic Significance of Maximum Primary Tumor Diameter in Nasopharyngeal Carcinoma

“…Advances in diagnostic technology, radiotherapy techniques and the introduction of combined chemotherapy are obvious, important contributors to this achievement [16][17][18][19]. The staging system was originally designed to help predict prognosis, define treatment strategies, and evaluate the outcome of treatment.…”