title: Nasopharyngeal carcinoma in a low incidence European area : A prospective observational analysis from the Head and Neck Study Group of the Italian Society of Radiation Oncology (AIRO).
abstract: OBJECTIVE
  To evaluate the outcomes with respect to long-term survival and toxicity in patients with nasopharyngeal carcinoma (NPC) treated in a European country with low incidence.
  
  
  METHODS
  A prospective observational study carried out by the AIRO Head and Neck group in 12 Italian institutions included 136 consecutive patients treated with radiotherapy (RT) ± chemotherapy (CHT) for NPC (without distant metastasis) between January 1, 2008 and December 31, 2010.
  
  
  RESULTS
  The disease-specific survival (DSS), overall survival (OS), and disease-free survival (DFS) at 5 years were 92 (±2), 91 (±3), and 69 % (±5 %), respectively. Distant failure was the most frequent modality of relapse. The local, regional, and locoregional control at 5 years were 89 (±3), 93 (±3), and 84 % (±4 %), respectively. The incidence of acute and late toxicity and the correlations with different clinical/technical variables were analyzed. Neoadjuvant CHT prolongs radiotherapy overall treatment time (OTT) and decreases treatment adherence during concomitant chemoradiotherapy. An adequate minimum dose coverage to PTV(T) is a predictive variable well related to outcome.
  
  
  CONCLUSIONS
  Our data do not substantially differ in terms of survival and toxicity outcomes from those reported in larger series of patients treated in countries with higher incidences of NPC. The T stage (TNM 2002 UICC classification) is predictive of DSS and OS. The GTV volume (T ± N) and an adequate minimum PTV(T) coverage dose (D95 %) were also identified as potential predictive variables. Sophisticated technologies of dose delivery (IMRT) with image-guided radiotherapy could help to obtain better minimum PTV(T) coverage dose with increased DFS; distant metastasis after treatment still remains an unresolved issue.
authors.affiliation: Istituto del Radio, Brescia University, A.O. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. sandro.tonoli@asst-spedalicivili.it.
authors.forename: S
authors.identifier: http://orcid.org/0000-0003-4060-7029
authors.initials: S
authors.lastname: Tonoli
authors.affiliation: Milan-European Institute of Oncology, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Alterio
authors.affiliation: Roma-Isola Tiberina Hospital, Rome, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Caspiani
authors.affiliation: IRCCS A.O.U. San Martino IST Genoa, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Bologna-S.Orsola Hospital, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bunkheila
authors.affiliation: Roma-S.Camillo Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cianciulli
authors.affiliation: Busto Arsizio Hospital, Busto Arsizio, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Merlotti
authors.affiliation: Milan University - Monza S. Gerardo Hospital, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Podhradska
authors.affiliation: Turin University, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rampino
authors.forename: D
authors.initials: D
authors.lastname: Cante
authors.affiliation: Treviglio Hospital, Treviglio, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bruschieri
authors.affiliation: Istituto del Radio, Brescia University, A.O. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Gatta
authors.affiliation: Istituto del Radio, Brescia University, A.O. Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.|Prato Hospital, Prato, Italy.
authors.forename: S M
authors.initials: SM
authors.lastname: Magrini
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D059248:Chemoradiotherapy / Q000379:methods* / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000517:prevention & control*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000401:mortality* / Q000517:prevention & control; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Chemotherapy; Prognosis; Radiotherapy; Survival; Toxicity