title: Treatment of stage IV(A-B) nasopharyngeal carcinoma by induction-concurrent chemoradiotherapy and accelerated fractionation.
abstract: OBJECTIVE
  To explore a more effective strategy for treating nasopharyngeal carcinoma with extensive locoregional disease.
  
  
  METHODS
  Between October 1998 and January 2003, 49 patients with Stage IV(A-B) disease infiltrating or abutting neurologic structures were treated with induction-concurrent chemotherapy and accelerated radiotherapy (RT). A combination of cisplatin and 5-fluorouracil was used in the induction phase and single-agent cisplatin in the concurrent phase. All patients were irradiated with conformal techniques at 2 Gy/fraction, six daily fractions weekly, to a total dose of 70 Gy.
  
  
  RESULTS
  Although 92% of patients had one or more acute toxicities Grade 3 or worse, 96% completed the whole course of RT, and 92% had five or more cycles of chemotherapy. The great majority of toxicities were uneventful, but 1 patient died of neutropenic sepsis. With a median follow-up of 3.1 years, 20 patients had failure at one or more sites and 15 patients died. The 3-year locoregional and distant failure-free rate was 77% and 75%, respectively, and the overall survival rate was 71%. At last follow-up, 27% of patients had developed late Grade 3 or worse toxicity (24% were hearing impairments), but none had radiation-induced neurologic damage.
  
  
  CONCLUSIONS
  The current strategy achieved encouraging results for this poor prognostic group, and confirmation of the therapeutic gain by a prospective randomized trial is warranted.
authors.affiliation: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China. awmlee@ha.org.hk
authors.forename: Anne W M
authors.initials: AW
authors.lastname: Lee
authors.forename: T K
authors.initials: TK
authors.lastname: Yau
authors.forename: Dominique H M
authors.initials: DH
authors.lastname: Wong
authors.forename: Elian W K
authors.initials: EW
authors.lastname: Chan
authors.forename: Rebecca M W
authors.initials: RM
authors.lastname: Yeung
authors.forename: W T
authors.initials: WT
authors.lastname: Ng
authors.forename: Macy
authors.initials: M
authors.lastname: Tong
authors.forename: Inda S
authors.initials: IS
authors.lastname: Soong
authors.forename: W M
authors.initials: WM
authors.lastname: Sze
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D020266:Radiotherapy, Conformal; D012074:Remission Induction; D012189:Retrospective Studies
chemical_list: D002945:Cisplatin; D005472:Fluorouracil