Improvement of local control of T3 and T4 nasopharyngeal carcinoma by hyperfractionated radiotherapy and concomitant chemotherapy.
OBJECTIVE
When the primary tumor of nasopharyngeal carcinoma (NPC) is treated at the base of skull and intracranium with conventional radiotherapy, the result is generally poor. In this report, we investigated whether hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT) could achieve better local control and survival in NPC patients with T3 and T4 lesions.


METHODS
Forty-eight patients (11 T3 and 37 T4 NPC) were treated with HFRT and CCT. HFRT was administered at 1.2 Gy per fraction, two fractions per day, Monday-Friday for 62 fractions for a total dose of 74.4 Gy. Concomitant chemotherapy consisting of cis-diamino-dichloroplatinum (CDDP) alone or CDDP and 5-fluorouracil was delivered simultaneously with radiotherapy during Weeks 1 and 6. Adjuvant chemotherapy consisted of CDDP and 5-fluorouracil for 2 to 3 cycles and was given monthly beginning 1 month after completion of radiation.


RESULTS
With a median follow-up of 57 months (range: 28-94 months), the 3-year locoregional control rate was 93%, the disease-free survival rate was 71%, and the overall survival rate was 72%. For T4 patients, the 3-year locoregional control rate was 91%, disease-free survival was 62%, and overall survival was 63%. The major acute toxicity was Grade 3 mucositis in 73% and Grade 2 weight loss in 31% of patients. Fifty percent of patients were tube fed. Most patients tolerated the combined modality treatments relatively well; 88% of patients completed their radiation treatment within 8 weeks.


CONCLUSIONS
HFRT and CCT for T3 and T4 NPC were associated with excellent local control and improved survival. The treatment-related toxicity was acceptable and reversible. We would recommend using HFRT with CCT for advanced T-stage NPC if the three-dimensional conformal radiation planning shows a significant portion of the brainstem to be inside the treatment field.
Jian
James Jer-Min
JJ
Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Pei-Tou, Taipei, Taiwan. jamesjian@mail.kfcc.org.tw
Cheng
Skye Hongiun
SH
Tsai
Stella Yu-Chen
SY
Yen
Kai-Cheng Lawrence
KC
Chu
Nei-Min
NM
Chan
Kwan-Yee
KY
Tan
Tran-Der
TD
Cheng
Jason Chia-Hsien
JC
Lin
Yen-Chun
YC
Leu
Szu-Yun
SY
Hsieh
Cheng-I
CI
Tsou
Mei-Hua
MH
Lin
Ching-Yuan
CY
Huang
Andrew T
AT
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010349:Patient Compliance; D013280:Stomatitis / Q000209:etiology; D015996:Survival Rate; D015431:Weight Loss
D002945:Cisplatin; D005472:Fluorouracil