title: Concurrent image-guided intensity modulated radiotherapy and chemotherapy following neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma.
abstract: BACKGROUND
  To evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  Between August 2006 and December 2009, 28 patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction.
  
  
  RESULTS
  After completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively.
  
  
  CONCLUSIONS
  HT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings.
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Pei-Wei
authors.initials: PW
authors.lastname: Shueng
authors.forename: Bing-Jie
authors.initials: BJ
authors.lastname: Shen
authors.forename: Le-Jung
authors.initials: LJ
authors.lastname: Wu
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Liao
authors.forename: Chi-Huang
authors.initials: CH
authors.lastname: Hsiao
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lin
authors.forename: Po-Wen
authors.initials: PW
authors.lastname: Cheng
authors.forename: Wu-Chia
authors.initials: WC
authors.lastname: Lo
authors.forename: Yee-Min
authors.initials: YM
authors.lastname: Jen
authors.forename: Chen-Hsi
authors.initials: CH
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000188:drug therapy* / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D020360:Neoadjuvant Therapy / Q000379:methods*; D011874:Radiometry / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012008:Recurrence; D012044:Regression Analysis; D016896:Treatment Outcome