title: Long-term results of concurrent chemoradiotherapy for T3/T4 locally advanced nasopharyngeal carcinoma.
abstract: Nasopharyngeal carcinoma (NPC) is one of the most commonly diagnosed head and neck malignancies. This study investigated the outcome of locally advanced NPC patients on concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF). A total of 226 patients with locally advanced NPC received IMRT, with a total dose of 65-70 Gy and concurrent chemotherapy, with 2 cycles of TPF administered during radiotherapy, between March, 2005 and March, 2007. An additional 2 to 4 cycles of chemotherapy were administered every 21 days following radiotherapy. With a median follow-up time of 35 months (range, 7-60), the 5-year overall survival (OS) rate was 81.4%, with 93.6 and 75.0% for T3 and T4 lesions, respectively, (P=0.001). The 5-year progression-free survival (PFS) was 50.4%, with 66.7 and 46.9% for T3 and T4 lesions, respectively (P<0.001). T-classification was a significant prognostic factor for PFS and OS. The subgroup analysis revealed that pterygopalatine fossa invasion was associated with a significantly lower 5-year PFS (P=0.001) and OS (P=0.002), foramen rotundum invasion was associated with a significantly lower 5-year PFS (P<0.001) and OS (P=0.004), foramen ovale invasion was associated with a significantly lower 5-year PFS (P=0.013) and OS (P=0.024) and foramen lacerum and cavernous sinus invasion were associated with a significantly lower 5-year PFS (P<0.001 and P<0.001, respectively). Concurrent chemoradiotherapy is an advocated regimen for patients with locally advanced NPC, since it exhibits satisfactory 5-year PFS and OS rates. Our results suggest that the estimation of invasive range may identify a subgroup of patients with a higher risk of locoregional failure who may be better candidates for this treatment strategy.
authors.affiliation: Departments of Stomatology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215006;
authors.forename: Can
authors.initials: C
authors.lastname: Xiao
authors.affiliation: Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215006;
authors.forename: Lili
authors.initials: L
authors.lastname: Wang
authors.affiliation: School of Radiation Medicine and Protection, Medical College of Soochow University, Soochow University, Suzhou, Jiangsu 215123, P.R. China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Jiao
authors.affiliation: School of Radiation Medicine and Protection, Medical College of Soochow University, Soochow University, Suzhou, Jiangsu 215123, P.R. China.
authors.forename: Kekang
authors.initials: K
authors.lastname: Sun
authors.affiliation: Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215006;
authors.forename: Songbing
authors.initials: S
authors.lastname: Qin
authors.affiliation: Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215006;
authors.forename: Xiaoting
authors.initials: X
authors.lastname: Xu
authors.affiliation: Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215006;
authors.forename: Jian
authors.initials: J
authors.lastname: Guo
authors.affiliation: Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu 215006;
authors.forename: Juying
authors.initials: J
authors.lastname: Zhou
keywords: chemotherapy; intensity-modulated radiation therapy; nasopharyngeal carcinoma