title: Effectiveness and toxicities of intensity-modulated radiation therapy for patients with T4 nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the effectiveness and toxicities in T4 nasopharyngeal carcinoma (NPC) using intensity-modulated radiotherapy (IMRT) combined with chemotherapy.
  
  
  METHODS
  This is a retrospective analysis of 81 patients treated with intensity-modulated radiotherapy (IMRT). All the primary tumors were attributed to T4 stage according to the AJCC2010 staging system. And the distribution of disease by N stage was N0 in 13.6%, N1 in 30.9%, N2 in 37%, and N3 in 18.5%. Cisplatin-based chemotherapy was offered to all patients. Radiotherapy-related toxicities were graded according to the Acute and the Late Radiation Morbidity Scoring Criteria of the Radiation Therapy Oncology Group (RTOG) scoring criteria. Chemotherapy-related toxicities were graded by National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 3.0. Prognostic factors were assessed by univariate analysis.
  
  
  RESULTS
  With a median follow-up of 37 months, 12 patients experienced local regional failure and total distant metastasis occurred in 18 patients, representing the major mode of failure. Ten patients died. Among them, 70% died of distant metastasis. The 3-year actuarial rates of local failure-free survival (LFFS), regional failure-free survival (RFFS), distant failure-free survival (DFFS), overall survival (OS), and progression-free survival (PFS) were 83.8%, 97.4%, 81.3%, 90%, and 69.7%, respectively. Acute and late toxicities were mild or moderate.
  
  
  CONCLUSIONS
  IMRT provides excellent local-regional control for T4 NPC. Distant metastasis remains the major cause of treatment failure. Further explorations of the sequence and regimen of systemic therapy are needed in the future.
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Fang-Fang
authors.initials: FF
authors.lastname: Kong
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Ying
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Cheng-Run
authors.initials: CR
authors.lastname: Du
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Jun-Jun
authors.initials: JJ
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
authors.forename: Chao-Su
authors.initials: CS
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D002648:Child; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D002945:Cisplatin