title: Excellent survival regardless of disease stage in patients with advanced nasopharyngeal cancer.
abstract: BACKGROUND
  We present our experience in assessing the feasibility and efficacy outcomes of intensified intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) delivered to patients with nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  Between March 2009 and December 2014, 35 patients affected by advanced NPC with a median age of 53 years (range 11-77) were treated with definitive radiotherapy. Radiotherapy was delivered by helical tomotherapy with the SIB technique. The prescribed doses were 66 Gy to macroscopic disease, 60 Gy to high-risk subclinical disease, and 54 Gy to low-risk disease in 30 fractions. The daily SIB dose was 2.2 Gy to macroscopic disease.
  
  
  RESULTS
  At the end of treatment 33 (94%) patients had obtained complete clearance of disease and 2 patients had died (1 of persistent disease after 3 months and 1 of cancer-unrelated causes after 4 months). At a median follow-up of 40 months (range 5-69), locoregional control rates at 2 and 4 years were 92.9% and 88.2%, respectively, and the overall survival after 4 years was 93.9%. The most significant acute toxicities were grade 2 and 3 mucositis (43%). No grade 3 and 4 late toxicities were observed; grade 2 xerostomia after 6 months from the end of treatment was reported in 11 patients; xerostomia toxicity decreased to grade 1 in 6/11 patients within 12 months.
  
  
  CONCLUSIONS
  These results show that intensified IMRT with SIB is an excellent strategy offering high local control rates for NPC patients with mild acute and late toxicity.
authors.affiliation: Division of Radiation Oncology, AOU IRCCS San Martino - IST National Cancer Research Institute and University, Genoa - Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Belgioia
authors.affiliation: Division of Radiation Oncology, AOU IRCCS San Martino - IST National Cancer Research Institute and University, Genoa - Italy.
authors.forename: Almalina
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Division of Medical Oncology, AOU IRCCS San Martino - IST National Cancer Research Institute and University, Genoa - Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Vecchio
authors.affiliation: Division of Radiation Oncology, AOU IRCCS San Martino - IST National Cancer Research Institute and University, Genoa - Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Marcenaro
authors.affiliation: Division of Medical Physics, AOU IRCCS San Martino - IST National Cancer Research Institute and University, Genoa - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pupillo
authors.affiliation: Division of Medical Physics, AOU IRCCS San Martino - IST National Cancer Research Institute and University, Genoa - Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Agostinelli
authors.affiliation: Division of Radiation Oncology, AOU IRCCS San Martino - IST National Cancer Research Institute and University, Genoa - Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Corvò
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult