title: Combined chemo-radiotherapy in locally advanced nasopharyngeal carcinomas.
abstract: OBJECTIVE
  To provide efficacy and safety data about the combined use of radiotherapy and chemo-radiotherapy in nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  We reviewed data of 40 patients with locally advanced NPC treated with induction chemotherapy followed by concomitant chemo-radiotherapy (CCRT) (22/40 patients) or CCRT alone (18/40) from March 2006 to March 2012. Patients underwent fiberoscopy with biopsy of the primitive tumor, and computed tomography scan of head, neck, chest and abdomen with and without contrast. Cisplatin was used both as induction and as concomitant chemotherapy, while 3D conformal radiation therapy was delivered to the nasopharynx and relevant anatomic regions (total dose, 70 Gy). The treatment was performed using 6 MV photons of the linear accelerator administered in 2 Gy daily fraction for five days weekly. This retrospective analysis was approved by the review boards of the participating institutions. Patients gave their consent to treatment and to anonymous analysis of clinical data.
  
  
  RESULTS
  Thirty-three patients were males and 7 were females. Median follow-up time was 58 mo (range, 1-92 mo). In the sub-group of twenty patients with a follow-up time longer than 36 mo, the 3-year survival and disease free survival rates were 85% and 75%, respectively. Overall response rate both in patients treated with induction chemotherapy followed by CCRT and in those treated with CCRT alone was 100%. Grade 3 neutropenia was the most frequent acute side-effect and it occurred in 20 patients. Grade 2 mucositis was seen in 29 patients, while grade 2 xerostomia was seen in 30 patients. Overall toxicity was manageable and it did not cause any significant treatment delay. In the whole sample population, long term toxicity included grade 2 xerostomia in 22 patients, grade 1 dysgeusia in 17 patients and grade 1 subcutaneous fibrosis in 30 patients.
  
  
  CONCLUSIONS
  Both CCRT and induction chemotherapy followed by CCRT showed excellent activity in locally advanced NPC. The role of adjuvant chemotherapy remains to be defined.
authors.affiliation: Francesco Perri, Francesco Caponigro, Head and Neck Medical Oncology Unit, National Tumor Institute of Naples, 80131 Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perri
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Della Vittoria Scarpati
authors.forename: Carlo
authors.initials: C
authors.lastname: Buonerba
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Longo
authors.forename: Paolo
authors.initials: P
authors.lastname: Muto
authors.forename: Concetta
authors.initials: C
authors.lastname: Schiavone
authors.forename: Fabio
authors.initials: F
authors.lastname: Sandomenico
authors.forename: Francesco
authors.initials: F
authors.lastname: Caponigro
keywords: Adjuvant chemotherapy; Concurrent chemoradiotherapy; Induction chemotherapy; Locally advanced disease; Nasopharyngeal carcinoma