title: Further improvement in outcomes of nasopharyngeal carcinoma with optimized radiotherapy and induction plus concomitant chemotherapy: an update of the Milan experience.
abstract: OBJECTIVE
  To report the outcome of a consecutive series of patients with nonmetastatic nasopharyngeal carcinoma (NPC), focusing on the impact of treatment-related factors.
  
  
  METHODS
  Between 2000 and 2006, 87 patients with NPC were treated with either conventional (two- or three-dimensional) radiotherapy (RT) or with intensity-modulated RT (IMRT). Of these patients, 81 (93%) received either concomitant CHT (24%) or both induction and concomitant chemotherapy (CHT) (69%). Stage was III in 36% and IV in 39% of patients. Outcomes in this study population were compared with those in the previous series of 171 patients treated during 1990 to 1999.
  
  
  RESULTS
  With a median follow-up of 46 months, actuarial rates at 3 years were the following: local control, 96%; local-regional control, 93%; distant control (DC), 90%; disease-free survival (DFS), 82%; overall survival, 90%. In Stage III to IV patients, distant control at 3 years was 56% in patients treated with concomitant CHT only and 92% in patients treated with both induction and concomitant CHT (p = 0.014). At multivariate analysis, histology, N-stage, RT technique, and total RT dose had the strongest independent impact on DFS (p < 0.05). Induction CHT had a borderline effect on DC (p = 0.07). Most dosimetric statistics were improved in the group of patients treated with IMRT compared with conventional 3D technique. All outcome endpoints were substantially better in the study population compared with those in the previous series.
  
  
  CONCLUSIONS
  Outcome of NPC has further improved in the study period compared with the previous decade, with a significant effect of RT technique optimization. The impact of induction CHT remains to be demonstrated in controlled trials.
authors.affiliation: Unit of Radiotherapy, Istituto Nazionale Tumori, Milan, Italy. mauro.palazzi@istitutotumori.mi.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Palazzi
authors.forename: Ester
authors.initials: E
authors.lastname: Orlandi
authors.forename: Paolo
authors.initials: P
authors.lastname: Bossi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pignoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Potepan
authors.forename: Marco
authors.initials: M
authors.lastname: Guzzo
authors.forename: Marzia
authors.initials: M
authors.lastname: Franceschini
authors.forename: Gabriele
authors.initials: G
authors.lastname: Scaramellini
authors.forename: Giulio
authors.initials: G
authors.lastname: Cantù
authors.forename: Lisa
authors.initials: L
authors.lastname: Licitra
authors.forename: Patrizia
authors.initials: P
authors.lastname: Olmi
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D000077143:Docetaxel; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated; D012074:Remission Induction; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D002945:Cisplatin; D005472:Fluorouracil