title: Concurrent chemoradiotherapy with adjuvant chemotherapy for high-risk nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the impact of invasion of the prevertebral or parapharyngeal spaces and large tumor volume on treatment outcomes in patients with nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  A total of 105 patients with newly diagnosed NPC were enrolled in this study. TNM stage and presence of invasion of the prevertebral or parapharyngeal spaces were recorded. All patients received a total dose of 70-75 Gy.
  
  
  RESULTS
  After controlling for age, sex, and chemotherapy status, invasion of the prevertebral or parapharyngeal spaces and large primary tumor volume produced a significantly increased hazard ratio for distant metastasis and recurrence. We defined patients with two or more such prognostic factors as high-risk patients, in whom the 3-year metastasis-free survival rate, with and without adjuvant chemotherapy, was 100% and 69.6%, respectively (P=0.02). Their 3-year recurrence-free survival rate, with and without adjuvant chemotherapy, was 93.3% and 70.2% (P=0.09). This benefit was not observed in low-risk NPC patients.
  
  
  CONCLUSIONS
  NPC patients with any two or more of the factors, involvement of the prevertebral space, large primary tumor volume, or advanced parapharyngeal space invasion, had more recurrence and poor survival rates and benefited from concurrent chemoradiotherapy followed by adjuvant chemotherapy.
authors.affiliation: Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
authors.forename: Sau-Tung
authors.initials: ST
authors.lastname: Chu
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009305:Nasopharynx / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010614:Pharynx / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil