title: Outcome and long-term efficacy of four facio-cervical fields conformal radiotherapy for nasopharyngeal carcinoma.
abstract: OBJECTIVE
  To evaluate the outcomes of 255 patients with nasopharyngeal carcinoma (NPC) treated with four facio-cervical fields conformal radiotherapy (4F-CRT).
  
  
  RESULTS
  In one patient's 3 different RT treatment modalities, the 4F-CRT techniques resulted in sharper of the dose-volume histograms (DVHs) for primary gross tumor volume (PGTVnx) and planning target volume (PTVnx), similar to the intensity modulated radiation therapy (IMRT). The median follow-up duration was 43 months. Locoregional relapse and distant metastases as the first treatment failure events occurred in 32 (32/255, 12.5%) and 20 (30/255, 11.8%) patients, respectively. The 3-year and 5-year local control, disease-free survival, and overall survival rates were 83.3%, 82%, 83.8%, and 76.1%, 73.2%, 76.3% respectively. Univariate analysis displayed that clinical stage, T-stage, N-stage, and tumor response were related to prognosis. Multivariate analysis indicated that age, T-stage, N-stage, and combined chemotherapy were independent prognosticators. The incidence of grade 1-2 acute mucositis and leukocytopenia were 93.7% and 91.0%, respectively, with no cases of grade 4 toxicity detected.
  
  
  METHODS
  From November 2007 to December 2011, 255 patients with histologically diagnosed, non-metastatic NPC were enrolled into this study and received 4F-CRT. Magnetic resonance imaging scans of the nasopharynx were performed on every patient. All patients received definitive radiotherapy with 6 MV X-rays using conventional fractions at 2 Gy daily, 5 fractions per week, and 231 patients with stage IIb-IV received concurrent chemotherapy and cisplatin-based adjuvant chemotherapy. The accumulated survival was calculated according to the Kaplan-Meier method; the log-rank test was used to compare survival differences. Multivariate analysis was performed using Cox's proportional hazard model.
  
  
  CONCLUSIONS
  Compared with the conventional treatment plans, the 4F-CRT plan delivered more dose to cover the tumor volume and reduces the doses of the normal tissues including the parotid gland, TMJs and so on. The long-term efficacy of 4F-CRT is satisfactory and its toxicities are tolerable.
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.|Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
authors.forename: Wang
authors.initials: W
authors.lastname: Fangzheng
authors.affiliation: Department of Breast Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Chuner
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.|Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
authors.forename: Wang
authors.initials: W
authors.lastname: Lei
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.|Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
authors.forename: Chen
authors.initials: C
authors.lastname: Weijun
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.|Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
authors.forename: Xu
authors.initials: X
authors.lastname: Min
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.|Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
authors.forename: Sun
authors.initials: S
authors.lastname: Quanquan
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.|Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
authors.forename: Liu
authors.initials: L
authors.lastname: Tongxin
authors.affiliation: Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan.
authors.forename: Rihito
authors.initials: R
authors.lastname: Aizawa
authors.affiliation: Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan.
authors.forename: Masoto
authors.initials: M
authors.lastname: Sakamoto
authors.affiliation: Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.|Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
authors.forename: Fu
authors.initials: F
authors.lastname: Zhenfu
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D015996:Survival Rate
keywords: chemotherapy; conformal radiotherapy; efficacy; nasopharyngeal neoplasm; prognosis