title: Long-Term Results of Concurrent Chemoradiotherapy for Advanced N2-3 Stage Nasopharyngeal Carcinoma.
abstract: BACKGROUND
  N-stage is related to distant metastasis in nasopharyngeal carcinoma (NPC) patients. The purpose of this study was to evaluate the efficacy and toxicity of different nedaplatin-based chemotherapy regimens in advanced N2-3 stage NPC patients treated with intensity modulated radiation therapy (IMRT).
  
  
  METHODS
  Between April 2005 and December 2009, a total of 128 patients with N2-3 advanced NPC were retrospectively analyzed. Patients were treated with IMRT concurrent with 2 cycles of chemotherapy consisting of either nedaplatin plus paclitaxel (NP group, n = 67) or nedaplatin plus fluorouracil and paclitaxel (NFP group, n = 61). Two to four cycles of adjuvant chemotherapy were then administered every 21 days following concurrent chemoradiotherapy.
  
  
  RESULTS
  With a median follow-up of 60 months, the 5-year overall survival (OS), progression-free survival (PFS), local-regional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) for all patients were 81.4%, 71.5%, 87.8% and 82.0%, respectively. No significant difference in PFS (66.6% vs. 76.7%, P = 0.212) and LRRFS rates (89.0% vs. 86.3%, P = 0.664) was observed between the NP and NFP groups. The 5-year OS (75.4% vs. 88.5%, P = 0.046) and DMFS (75.1% vs. 89.0%, P = 0.042) rate were superior in the NFP group compared with the NP group. The NFP group had a higher incidence of grade 3-4 acute toxicities including bone marrow suppression (leukopenia: χ2 = 3.935, P = 0.047; anemia: χ2 = 9.760, P = 0.002; thrombocytopenia: χ2 = 8.821, P = 0.003), and both liver and renal dysfunction (χ2 = 5.206, P = 0.023) compared with the NP group. Late toxicities were moderate and no difference was observed between the two groups.
  
  
  CONCLUSIONS
  IMRT concurrent with nedaplatin-based chemotherapy is an advocated regimen for patients with advanced N2-3 stage NPC. Patients with advanced N2-3 stage may be better candidates for the NFP regimen although this regimen was associated with a high acute toxicity rate.
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Yin
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Xiu-Hua
authors.initials: XH
authors.lastname: Bian
authors.affiliation: Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, P. R. China.
authors.forename: Xue
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Meng
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Pu-Dong
authors.initials: PD
authors.lastname: Qian
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Xue-Song
authors.initials: XS
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Huan-Feng
authors.initials: HF
authors.lastname: Zhu
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Jia-Jia
authors.initials: JJ
authors.lastname: Gu
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Wu
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Ye-wei
authors.initials: YW
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Nanjing Medical University Affiliated Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, P. R. China.
authors.forename: Xia
authors.initials: X
authors.lastname: He
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use / Q000633:toxicity; D002277:Carcinoma; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000627:therapeutic use / Q000633:toxicity; D011379:Prognosis; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; C053989:nedaplatin