Carcinoma of the nasopharynx: factors affecting prognosis

Pérez, Carlos A.; Devineni, V.R.; Marcial-Vega, Víctor; Marks, Joe; Simpson, Joseph R.; Kucik, Nancy A.

doi:10.1016/0360-3016(92)90741-y

Cited by 222 publications

(104 citation statements)

References 30 publications

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“…5,6,28,29 The degree of xerostomia is dependent largely on the dose and volume of salivary gland in the radiation field. Studies have shown that salivary flows are markedly reduced after 10 to 15 Gy of RT.…”

Section: Discussionmentioning

confidence: 99%

Intensity-Modulated Radiation Therapy With or Without Chemotherapy for Nasopharyngeal Carcinoma: Radiation Therapy Oncology Group Phase II Trial 0225

Lee

Harris

Garden

et al. 2009

JCO

629

524

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A B S T R A C T PurposeTo investigate the feasibility of intensity-modulated radiation therapy (IMRT) with or without chemotherapy, and to assess toxicities, failure patterns, and survivals in patients with nasopharyngeal carcinoma (NPC). Patients and MethodsRadiation consisted of 70 Gy given to the planning target volumes of primary tumor plus any Nϩ disease and 59.4 Gy given to subclinical disease, delivered over 33 treatment days. Patients with stage T2b or greater or with Nϩ disease also received concurrent cisplatin (100 mg/m 2 ) on days 1, 22, and 43 followed by adjuvant cisplatin (80 mg/m 2 ) on day 1; fluorouracil (1,000 mg/m 2 /d) on days 1 through 4 administered every 4 weeks for three cycles. Tumor, clinical status, and acute/late toxicities were assessed. The primary objective was to test the transportability of IMRT to a multi-institutional setting. February 2003 and November 2005, 68 patients with stages I through IVB NPC (of which 93.8% were WHO types 2 and 3) were enrolled. Prescribed IMRT (target delineation) was given to 83.8%, whereas 64.9% received chemotherapy per protocol. The estimated 2-year local progression-free (PF), regional PF, locoregional PF, and distant metastasis-free rates were 92.6%, 90.8%, 89.3%, and 84.7%, respectively. The estimated 2-year PF and overall survivals were 72.7% and 80.2%, respectively. Acute grade 4 mucositis occurred in 4.4%, and the worst late grade 3 toxicities were as follows: esophagus, 4.7%; mucous membranes, 3.1%; and xerostomia, 3.1%. The rate of grade 2 xerostomia at 1 year from start of IMRT was 13.5%. Only two patients complained of grade 3 xerostomia, and none had grade 4 xerostomia. Results Between ConclusionIt was feasible to transport IMRT with or without chemotherapy in the treatment of NPC to a multi-institutional setting with 90% LRPF rate reproducing excellent reports from single institutions. Minimal grade 3 and lack of grade 4 xerostomia were encouraging.

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Section: Discussionmentioning

confidence: 99%

Intensity-Modulated Radiation Therapy With or Without Chemotherapy for Nasopharyngeal Carcinoma: Radiation Therapy Oncology Group Phase II Trial 0225

Lee

Harris

Garden

et al. 2009

JCO

629

524

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“…Local control may be related to the total dose of radiation given through external beam radiotherapy (EBRT) alone or combined with brachytherapy. Previous studies report an acceptable incidence of side effects with cumulative doses of up to 81 Gy to the nasopharynx proper [2][3][4]. Neoadjuvant chemotherapy was found to improve outcomes in randomized studies.…”

Section: Introductionmentioning

confidence: 98%

Brachytherapy Boost in Loco-regionally Advanced Nasopharyngeal Carcinoma: A Prospective Randomized Trial of the International Atomic Energy Agency

Rosenblatt

El-Gantiry²,

Elattar³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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AbstactBackground: The purpose was to determine whether a brachytherapy boost improves outcomes in patients with advanced nasopharyngeal carcinoma treated with standard chemo-radiotherapy. Methods:Patients with nasopharyngeal carcinoma WHO grades I-III and TNM stages III or non-metastatic stage IV were eligible for this phase III study. Patients were randomized to either arm (A) induction chemotherapy, followed by external beam radiotherapy (EBRT) with concomitant cisplatin (n = 139) or arm (B), the same schedule plus a brachytherapy boost to the nasopharynx (n = 135). The EBRT doses given were 70 Gy to the primary tumour and positive lymph nodes and 46 Gy to the negative neck. The additional brachytherapy boost in arm (B) was given by either low dose-rate (LDR -11 Gy) or high dose-rate (HDR -3 fractions of 3.0 Gy) brachytherapy. The primary endpoint was 3-year overall survival (OS) and secondary endpoints were: local control, regional control, distant metastasis and grade 3-4 adverse events. Results: 274 patients were randomized between September 2004 and December 2008. The two arms were comparable with regard to age, gender, stage and grade. 273 patients completed treatment. Median follow-up was 29 months (0.2-67 months). The effect of treatment arm, country, age, gender, WHO pathology, stage (T3-4, N2-3 versus other) and chemotherapy on overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS) was studied. Stage significantly affected OS (p = 0.024) and DFS (p = 0.018) while age significantly affected OS (p = 0.014). None of the other factors studied were significant. The 3-year LRFS was 60.5% and 54.4% in arms A and B respectively (p = 0.647). The 3-year regional control rate in the neck was 59.7% and 54.3% respectively (p = 0.7). Distant metastasis developed in 59.7% of patients in arm A and 55.4% in arm B (p = 0.377). Patients with T1/T2 N + had a 3 year LRFS of 51.8% in Arm A (62 patients) versus 57.9% in Arm B (67 patients) (p = 0.343). The grade 3-4 toxicity rate was 21.6% (30/139) and 24.4% (33/135) respectively (p = 0.687).Conclusions: The addition of a brachytherapy boost to external beam radiotherapy and chemotherapy did not improve outcome in loco-regionally advanced nasopharyngeal carcinoma.

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“…The question of whether an increase in total dose as contributed by brachytherapy results in better control cannot be answered with this retrospective analysis. The correlation between total dose of primary RT and local control has been highlighted by Perez et al (15). By increasing the total dose from 66-70 Gy to more than 70 Gy, the local control rate of their AJCC T 1-3 tumours improved from 80% to 100%.…”

Section: Discussionmentioning

confidence: 91%

High Dose Rate Intracavitary Brachytherapy in the Treatment of Nasopharyngeal Carcinoma

et al. 1996

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Carcinoma of the nasopharynx: factors affecting prognosis

Cited by 222 publications

References 30 publications

Intensity-Modulated Radiation Therapy With or Without Chemotherapy for Nasopharyngeal Carcinoma: Radiation Therapy Oncology Group Phase II Trial 0225

Intensity-Modulated Radiation Therapy With or Without Chemotherapy for Nasopharyngeal Carcinoma: Radiation Therapy Oncology Group Phase II Trial 0225

Brachytherapy Boost in Loco-regionally Advanced Nasopharyngeal Carcinoma: A Prospective Randomized Trial of the International Atomic Energy Agency

High Dose Rate Intracavitary Brachytherapy in the Treatment of Nasopharyngeal Carcinoma

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