title: Simultaneous modulated accelerated radiation therapy and concurrent weekly Paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the feasibility and efficacy of simultaneous accelerated radiation therapy (SMART) and concurrent weekly paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma.
  
  
  METHODS
  Forty- one patients with pathologically confirmed nasopharyngeal carcinoma were treated by SMART with concurrent weekly paclitaxel. Daily fraction doses of 2.5 Gy and 2.0 Gy were prescribed to the gross tumor volume (GTV) and clinical target volume (CTV) to a total dose of 70 Gy and 56 Gy, respectively. Paclitaxel of 45 mg/m2 was administered concurrently with radiation therapy every week. Adjuvant chemotherapy was given four weeks after the completion of the radiotherapy (RT) if the tumor demonstrated only a partial response (PR).
  
  
  RESULTS
  All patients completed the radiotherapy (RT) course. Adjuvant chemotherapy was administered to 12 patients due to PR. The CR (complete remission) rate was 82.9% three months after RT. Thirty-nine (95.1%) patients completed the concurrent weekly chemotherapy with paclitaxel, and two patients skipped their sixth course. Seven patients had a 15% dosage reduction at the fifth and sixth course due to grade 3 mucositis. The median follow-up was 30 (range, 14-42) months. The three-year overall survival (OS), metastases-free survival (MFS), and local control rates were 77.0%, 64.4%, and 97.6%, respectively. No correlation between survival rate and T or N stage was observed. Grade 3 acute mucositis and xerostomia were present in 17.1% and 7.1%, respectively.
  
  
  CONCLUSIONS
  SMART with concurrent weekly paclitaxel is a potentially effective and toxicity tolerable approach in the treatment of locally advanced NPC.
authors: Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College, Wenzhou, China. wzxiecongying@163.com
authors: Cong-Ying
authors: CY
authors: Xie
authors: Xian-Ce
authors: XC
authors: Jin
authors: Xia
authors: X
authors: Deng
authors: Sheng-Liu
authors: SL
authors: Xue
authors: Zhao
authors: Z
authors: Jing
authors: Hua-Fang
authors: HF
authors: Su
authors: Shi-Xiu
authors: SX
authors: Wu
mesh_terms: D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D052016:Mucositis / Q000139:chemically induced; D017239:Paclitaxel / Q000008:administration & dosage; D012074:Remission Induction
chemical_list: D017239:Paclitaxel