Concomitant Radiochemotherapy in the Management of Nasopharyngeal Carcinoma

Abstract

Purpose: To develop the results of concomitant radiochemotherapy in management of nasopharyngeal carcinoma (NPC) to the National Institute of Oncology at Rabat. Materials and methods: Retrospective study of 81 patients with nasopharyngeal carcinoma and who were treated with concomitant radiochemotherapy to the National Institute of Oncology at Rabat in radiotherapy department, for a period of January to December 2012. Results: Median age was 43 years old with male dominance to 78.8 %. According to TNM classification passed by AJCC 2010, 43.2% were classified stage IV, 37 % stage III and 19.8 % stage II. Neoadjuvant chemotherapy was indicated in 20 patients (24.7%) or 95% in N2-N3. The Therapeutic result after the neoadjuvant chemotherapy for lymph node was complete in 31.2 %. The concomitant radiochemotherapy treatment consisted in a conformal therapy treatment with lateral 6 MV photon beams dose of 70 Gy in conventional fractioning, and in two series by excluding spinal cord after dose of 40 Gy. We used electrons treatment in addition to treat the lymph nodes. The concomitant chemotherapy consisted of a weekly cisplatin treatment 40 mg/m2. The mean spread was 57.3 days. During the concomitant chemotherapy treatment 60 % of radiomucitis and 30 % nephrotoxicity were observed in patients receiving neoadjuvant chemotherapy. Late toxicities were dominated by hyposcialie (90.1%) and otological disorders (67.9%). After an average follow-up of 30.6 months, we were able to follow the progress of 69 patients (85.2%). Forty-nine patients (75.3%) were in good locoregional control. We observed 20 relapses (24.7 %) including 14 metastatic relapses. The main prognostic factors of metastasis were lymph node involvement in 92.2% (p = 0.04) and T3-T4 stages in 64.2% (p = 0.013). At three years, overall survival at all stages were to 81.9%, survival without recurrence to 71% and local control to 79.2%. Conclusion: The nasopharyngeal carcinoma are radiosensitive and radiocurable tumors. Concomitant radiochemotherapy is the therapeutic standard for locally advanced nasopharyngeal carcinoma, and allow to obtain carcinological good results at toxicity notable disadvantage.