Treatment outcome of patients with stages I-II nasopharyngeal carcinoma after late course accelerated hyperfractionation radiotherapy alone.
OBJECTIVE
To follow up the efficacy and incidence of radiation-induced complications of late course accelerated fractionation (LCAF) radiotherapy in early-stage nasopharyngeal carcinoma (NPC).


METHODS
From December 1995 to November 2002, 158 patients with stages I-II NPC were admitted for radiotherapy alone. For the first two-thirds of the treatment, 2 daily fractions of 1.2 Gy were given to the primary lesion, 5 days per week to a total dose of 48 Gy/40 fractions, over a period of 4 weeks. From the 5th week, an accelerated hyperfractionation schedule was carried out. Two daily fractions of 1.5 Gy were given, to a total dose of 30 Gy/20 fractions over 2 weeks. Thus the total dose was 78 Gy in 60 fractions in 6 weeks.


RESULTS
All patients completed the treatment. Acute mucositis: none in 3 patients, grade 1 in 32, grade 2 in 69, grade 3 in 51, and grade 4 in 3 patients. Five-year nasopharyngeal control and overall survival (OS) rate of T1 and T2 were 97.8%, 90.2% (p=0.380) and 88.6%, 81.4% (p=0.252), respectively. Five-year OS in N0 and N1 patients were 86.5% and 81.9% (p=0.033), respectively. Thirty-eight patients died, and the main cause of death was distant metastasis. Seventeen (11%) patients had radiation-induced cranial nerve palsy.


CONCLUSIONS
With LCAF, treatment-related toxicities were acceptable. Five-year nasopharyngeal control and OS in T2 stage were improved. Main cause of death was distant metastasis. Patients with N1 had a relatively lower survival rate, which suggested that chemotherapy might be indicated for those patients.
Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
Xiayun
X
He
Department of Radiation Oncology, Renji Hospital, Medical School of Shanghai Jiaotong University, Shanghai, PR China.
Ming
M
Ye
Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China. Electronic address: xiaomaoguosh@yahoo.cn.
Xiaomao
X
Guo
Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
Ziqiang
Z
Pan
Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
Zhen
Z
Zhang
Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
Shaoqin
S
He
Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
Taifu
T
Liu
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003389:Cranial Nerve Diseases / Q000209:etiology; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult