title: Dose escalation for patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone.
abstract: OBJECTIVE
  The local control of patients with locally advanced nasopharyngeal carcinoma is still unsatisfactory. This prospective study was designed to evaluate the treatment outcomes and treatment-related complications of patients with locally advanced nasopharyngeal carcinoma treated with escalated radiation doses.
  
  
  METHODS
  A total of 118 consecutive patients with T4 classification (1992 American Joint Committee on Cancer staging system), histology-proven nonmetastatic nasopharyngeal carcinoma were treated with radiotherapy alone between 1992 and 1997 in a medical center in southern Taiwan. Thirty-two of them were enrolled into a prospective study of dose escalation and were irradiated to a total of 81 Gy. The other 86 patients received a total of 70.2 Gy. Potentially significant patient-related and treatment-related parameters were analyzed for their prognostic significance. Radiation-related complications were recorded and analyzed.
  
  
  RESULTS
  The 5-year local progression-free rates were 61%, and 61% for patients receiving 70.2 Gy and 81 Gy, respectively (P > 0.05). The incidences of xerostomia, hearing impairment, and temporal radionecrosis were significantly higher for those receiving 81 Gy. The 5-year complication-free rates of patients receiving 70.2 Gy and 81 Gy were 14% versus 2% for xerostomia (P = 0.0070), 50% versus 30% for hearing impairment (P = 0.0198), and 91% versus 82% for temporal radionecrosis (P = 0.0400).
  
  
  CONCLUSIONS
  For patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone, dose escalation to 81 Gy failed to show benefits on local control rate. Higher radiation doses contribute to a higher incidence of radiation-related complications.
authors.affiliation: Department of Radiation Oncology, E-DA Hospital, Kaohsiung, Taiwan. yehsa@hotmail.com
authors.forename: Shyh-An
authors.initials: SA
authors.lastname: Yeh
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011446:Prospective Studies; D015996:Survival Rate; D013624:Taiwan