title: Neoadjuvant and Concurrent Chemotherapy Have Varied Impacts on the Prognosis of Patients with the Ascending and Descending Types of Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiotherapy.
abstract: OBJECTIVE
  To compare the outcomes of patients with ascending type (T4&N0-1) and descending type (T1-2&N3) of nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT), neoadjuvant chemotherapy (NACT) + intensity-modulated radiotherapy (RT) or NACT + CCRT.
  
  
  METHODS
  Retrospective analysis of 839 patients with ascending or descending types of NPC treated at a single institution between October 2009 to February 2012. CCRT was delivered to 236 patients, NACT + RT to 302 patients, and NACT + CCRT to 301 patients.
  
  
  RESULTS
  The 4-year overall survival rate, distant metastasis-free survival rate, local relapse-free survival rate, nodal relapse-free survival rate, loco-regional relapse-free survival rate, and progression free survival rate were 75.2% and 73.4% (P = 0.114), 85.7% and 74.1% (P = 0.008), 88.8% and 97.1% (P = 0.013), 96.9% and 94.1% (P = 0.122), 86.9% and 91.2% (P = 0.384), 73.7% and 66.2% (P = 0.063) in ascending type and descending type. Subgroup analyses indicated that NACT + RT significantly improved distant metastasis-free survival rate and progression-free survival rate when compared with CCRT in the ascending type, and there were no significant differences between the survival curves of NACT +RT and NACT + CCRT. For descending type, there were no significant differences among the survival curves of NACT +RT, CCRT, and NACT + CCRT groups, and the survival benefit mainly came from CCRT.
  
  
  CONCLUSIONS
  Compared with NACT + CCRT or CCRT, NACT + RT may be a reasonable approach for ascending type. Although concurrent chemotherapy was effective in descending type, NACT + CCRT may be a more appropriate strategy for descending type.
authors: Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.|Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519001, Guangdong Province, China.
authors: Ji-Jin
authors: JJ
authors: Yao
authors: Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.
authors: Guan-Qun
authors: GQ
authors: Zhou
authors: Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519001, Guangdong Province, China.
authors: Fan
authors: F
authors: Zhang
authors: Department of Medical Statistics and Epidemiology & Health Information Research Centre & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors: Wang-Jian
authors: WJ
authors: Zhang
authors: Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.
authors: Li
authors: L
authors: Lin
authors: Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.
authors: Ling-Long
authors: LL
authors: Tang
authors: Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.
authors: Yan-Ping
authors: YP
authors: Mao
authors: Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.
authors: Jun
authors: J
authors: Ma
authors: Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China.
authors: Ying
authors: Y
authors: Sun
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016896:Treatment Outcome