Concurrent image-guided intensity modulated radiotherapy and chemotherapy following neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

Abstract

BackgroundTo evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC).MethodsBetween August 2006 and December 2009, 28 patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction.ResultsAfter completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively.ConclusionHT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings.

Treatment of nasopharyngeal carcinoma by tomotherapy: five-year experience

“…Progression-free and overall survival was 79.7% and 95%, respectively. Shueng et al [23] followed 28 patients to a median of 33 months after neoadjuvant chemotherapy followed by concurrent chemoradiation including HT to 70 Gy to the tumor and positive nodes. The 3-year local, regional, locoregional control and distant metastasis rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively, and overall survival was 83.5%.…”

“…Although local control and survival have been enhanced by the introduction of IMRT into NPC treatment, the pattern of recurrence continues to show a relatively high rate of distant metastases [17,20,21,23], suggesting the continuing need for more effective systemic therapies. In addition, it cannot be determined whether the generally superior dose-sculpting capability of HT relative to more conventional IMRT leads to improved disease control and toxicity outcomes.…”

Clinical effectiveness, toxicity, and failure patterns of helical tomotherapy for postoperative oral cavity cancer patients

“…According to previous reports, HT plans compared favorably with step-and-shoot IMRT plans regarding sparing of organs at risk and keeping equivalent target-dose homogeneity 5,6. Our and other clinical experience of using HT for locally advanced head and neck cancer achieved encouraging results along with less toxicity 7–9…”

Prognostic Significance of Maximum Primary Tumor Diameter in Nasopharyngeal Carcinoma

“…Advances in diagnostic technology, radiotherapy techniques and the introduction of combined chemotherapy are obvious, important contributors to this achievement [16][17][18][19]. The staging system was originally designed to help predict prognosis, define treatment strategies, and evaluate the outcome of treatment.…”