title: Induction Chemotherapy Followed by Chemo-intensity-modulated Radiotherapy for Locally Advanced Nasopharyngeal Cancer.
abstract: To determine the toxicity and tumour control rates after chemo-intensity-modulated radiotherapy (chemo-IMRT) for locally advanced nasopharyngeal cancers (LA-NPC).
  
  
  
  Patients with LA-NPC were enrolled in a trial to receive induction chemotherapy followed by parotid-sparing chemo-IMRT. The primary site and involved nodal levels received 65 Gy in 30 fractions and at risk nodal levels received 54 Gy in 30 fractions. Incidence of ≥grade 2 subjective xerostomia was the primary end point. Secondary end points included incidences of acute and late toxicities and survival outcomes.
  
  
  
  Forty-two patients with American Joint Committee on Cancer stages II (12%), III (26%) and IV (62%) (World Health Organization subtype: I [5%]; II [40%]; III [55%]) completed treatment between January 2006 and April 2010 with a median follow-up of 32 months. Incidences of ≥grade 2 acute toxicities were: dysphagia 83%; xerostomia 76%; mucositis 97%; pain 76%; fatigue 99% and ototoxicity 12%. At 12 months, ≥grade 2 subjective xerostomia was observed in 31%, ototoxicitiy in 13% and dysphagia in 4%. Two year locoregional control was 86.2% (95% confidence interval: 70.0-94.0) with 2 year progression-free survival at 78.4% (61.4-88.6) and 2 year overall survival at 85.9% (69.3-93.9).
  
  
  
  Chemo-IMRT for LA-NPC is feasible with good survival outcomes. At 1 year, 31% experience ≥grade 2 subjective xerostomia.
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
authors.forename: A B
authors.initials: AB
authors.lastname: Miah
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Bhide
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Del Rosario
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Matthews
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Nicol
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Tanay
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: S H
authors.initials: SH
authors.lastname: Zaidi
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Newbold
authors.affiliation: Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Harrington
authors.affiliation: The Institute of Cancer Research, London, UK. Electronic address: chris.nutting@rmh.nhs.uk.
authors.forename: C M
authors.initials: CM
authors.lastname: Nutting
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods
keywords: Chemoradiotherapy; IMRT; nasopharyngeal cancer; radiotherapy; sequential