title: Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma. Treatment results and locoregional recurrence.
abstract: OBJECTIVE
  The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).
  
  
  METHODS
  Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33-35 fractions. In addition, 97% of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months.
  
  
  RESULTS
  The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1%, respectively. A total of 27 patients had locoregional recurrence: 85.2% in-field failures, 11.1% marginal failures, and 3.7% out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9%) compared to those receiving conservative treatment (32.0%, p=0.051). In patients treated with 1 course of radiotherapy, grade ≥3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6% of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation.
  
  
  CONCLUSIONS
  IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.
authors.affiliation: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, 100, Taipei, Taiwan.
authors.forename: J L-Y
authors.initials: JL
authors.lastname: Chen
authors.forename: Y-S
authors.initials: YS
authors.lastname: Huang
authors.forename: S-H
authors.initials: SH
authors.lastname: Kuo
authors.forename: Y-F
authors.initials: YF
authors.lastname: Chen
authors.forename: R-L
authors.initials: RL
authors.lastname: Hong
authors.forename: J-Y
authors.initials: JY
authors.lastname: Ko
authors.forename: P-J
authors.initials: PJ
authors.lastname: Lou
authors.forename: C-L
authors.initials: CL
authors.lastname: Tsai
authors.forename: W-Y
authors.initials: WY
authors.lastname: Chen
authors.forename: C-W
authors.initials: CW
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D002648:Child; D002945:Cisplatin / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D020266:Radiotherapy, Conformal / Q000401:mortality*; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin