title: Alternating chemoradiotherapy in patients with nasopharyngeal cancer: prognostic factors and proposal for individualization of therapy.
abstract: The purpose of this study is to assess the efficacy of alternating chemoradiation in patients with nasopharyngeal cancer. From 1990-2006, 100 patients with nasopharyngeal cancer were treated with alternating chemoradiation at the Aichi Cancer Center. Of these, 4, 2, 23, 34, 13 and 23 patients were staged as I, IIA, IIB, III, IVA and IVB, respectively. The median radiation doses for primary tumors and metastatic lymph nodes were 66.6 Gy (range, 50.4-80.2 Gy) and 66 Gy (range, 40.4-82.2 Gy), respectively. A total of 82 patients received chemotherapy with both cisplatin and 5-fluorouracil (5-FU), while 14 patients received nedaplatin (CDGP) and 5-FU. With a median follow-up of 65.9 months, the 5-year rates of overall survival (OAS) and progression-free survival (PFS) were 78.1% and 68.3%, respectively. On multivariate analysis (MVA), elderly age, N3, and WHO type I histology proved to be significantly unfavorable prognostic factors of OAS. As for PFS, there were T4, N3, and WHO type I histology in MVA. Acute toxicities of hematologic and mucositis/dermatitis ≥ Grade 3 were relatively high (32%); however, they were well-managed. Late toxicities of ≥ Grade 3 were three (3%) mandibular osteomyelitis and one (1%) lethal mucosal bleeding. Results for alternating chemoradiation for nasopharyngeal carcinoma are promising. In order to improve outcomes, usage of intensity-modulated radiation therapy and application of active anticancer agents are hopeful treatments, especially for groups with poor prognosis factors with WHO type I histopathology, T4 and/or N3 disease.
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. ygoto@kuhp.kyoto-u.ac.jp
authors.forename: Yoko
authors.initials: Y
authors.lastname: Goto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Fuwa
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Mizoguchi
authors.forename: Rie
authors.initials: R
authors.lastname: Nakahara
authors.forename: Motoo
authors.initials: M
authors.lastname: Nomura
authors.forename: Natsuo
authors.initials: N
authors.lastname: Tomita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tachibana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D059248:Chemoradiotherapy / Q000379:methods* / Q000401:mortality*; D002945:Cisplatin / Q000008:administration & dosage; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000628:therapy*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D015995:Prevalence; D011379:Prognosis; D011832:Radiation Injuries / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; C053989:nedaplatin; D002945:Cisplatin; D005472:Fluorouracil