Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma.
OBJECTIVE
To study the safety and efficacy of dose escalation in tumor for locally advanced nasopharyngeal carcinoma (NPC).


METHODS
From September 2000 to June 2004, 50 patients with T3-T4 NPC were treated with intensity-modulated radiotherapy (IMRT). Fourteen patients had Stage III and 36 patients had Stage IVA-IVB disease. The prescribed dose was 76 Gy to gross tumor volume (GTV), 70 Gy to planning target volume (PTV), and 72 Gy to enlarged neck nodes (GTVn). All doses were given in 35 fractions over 7 weeks. Thirty-four patients also had concurrent cisplatin and induction or adjuvant PF (cisplatin and 5-fluorouracil).


RESULTS
The average mean dose achieved in GTV, GTVn, and PTV were 79.5 Gy, 75.3 Gy, and 74.6 Gy, respectively. The median follow-up was 25 months, with 4 recurrences: 2 locoregional and 2 distant failures. All patients with recurrence had IMRT alone without chemotherapy. The 2-year locoregional control rate, distant metastases-free and disease-free survivals were 95.7%, 94.2%, and 93.1%, respectively. One treatment-related death caused by adjuvant chemotherapy occurred. The 2-year overall survival was 92.1%.


CONCLUSIONS
Dose escalation to 76 Gy in tumor is feasible with T3-T4 NPC and can be combined with chemotherapy. Initial results showed good local control and survival.
Kwong
Dora L W
DL
Department of Clinical Oncology, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. dlwkwong@hkucc.hku.hk
Sham
Jonathan S T
JS
Leung
Lucullus H T
LH
Cheng
Ashley C K
AC
Ng
W M
WM
Kwong
Philip W K
PW
Lui
W M
WM
Yau
C C
CC
Wu
P M
PM
Wei
William
W
Au
Gordon
G
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000150:complications; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013280:Stomatitis / Q000209:etiology; D016019:Survival Analysis
D002945:Cisplatin; D005472:Fluorouracil