title: Accelerated concomitant boost radiotherapy and chemotherapy for advanced nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the feasibility and efficacy of concomitant boost radiotherapy (RT) plus cisplatin-based chemotherapy compared with standard fractionation RT for patients with advanced nasopharyngeal cancer.
  
  
  METHODS
  From 1988 through 1999, 50 patients with American Joint Committee on Cancer stage II-IVb nasopharyngeal carcinoma were treated with 70-Gy concomitant boost RT (1.8 Gy/d, weeks 1 through 6; 1.6 Gy second daily fraction, weeks 5 through 6) and two cycles of concurrent cisplatin 100 mg/m(2) days 1 and 22. Thirty-seven patients also received three cycles of cisplatin-based adjuvant chemotherapy. These 50 patients were compared with a nonrandomized cohort of 51 patients with nasopharyngeal cancer treated with 70-Gy standard fractionation RT (1.8 Gy/d) without chemotherapy from 1988 through 1995. The groups were well matched for prognostic factors except stage, for which the concomitant boost RT/chemotherapy group was more advanced (54%, T3-4; 54%, N2-3; 44%, stage IV) compared with the standard RT group (31%, T3-4, P =.03; 22%, N2-3, P <.001; 20%, stage IV, P <.01).
  
  
  RESULTS
  With a median follow-up of 42 months (range, 12 to 129 months), the 3-year actuarial local control, progression-free survival, and survival rates were 89% v 74% (P <.01), 66% v 54% (P =.01), and 84% v 71% (P =.04) for the concomitant boost RT/chemotherapy group and the standard RT patients, respectively. Acute grade 3 mucositis was more prevalent with combined therapy, 84% v 43% (P <.001), resulting in a higher rate of temporary gastrostomy tube placement, 46% v 20% (P <.01).
  
  
  CONCLUSIONS
  Concomitant boost RT with cisplatin-based chemotherapy is feasible and improves local-regional control as well as survival for patients with advanced nasopharyngeal cancer compared with standard RT alone.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. woldens@mskcc.org
authors.forename: S L
authors.initials: SL
authors.lastname: Wolden
authors.forename: M J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: D H
authors.initials: DH
authors.lastname: Kraus
authors.forename: K E
authors.initials: KE
authors.lastname: Rosenzweig
authors.forename: L M
authors.initials: LM
authors.lastname: Chong
authors.forename: A R
authors.initials: AR
authors.lastname: Shaha
authors.forename: H
authors.initials: H
authors.lastname: Zhang
authors.forename: L B
authors.initials: LB
authors.lastname: Harrison
authors.forename: J P
authors.initials: JP
authors.lastname: Shah
authors.forename: D G
authors.initials: DG
authors.lastname: Pfister
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000628:therapy*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D016019:Survival Analysis
chemical_list: D002945:Cisplatin; D005472:Fluorouracil