ABSTRACT
Purpose: To evaluate the feasibility and efficiency of concurrent chemo-radiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients. Patients and Methods: We reviewed data of 33 non-metastatic NPC patients who had been treated with CCRT between January 2004 and December 2006. The Median age of patients was 41 year-old and the male/female ratio was 3. According to the 2002 TNM staging system, T3-T4 locally advanced tumors and N2-N3 nodal status rates were 67% and 46%, respectively. All patients had undifferentiated carcinoma and received conventional fractionated 2D conventional radiotherapy (RT) with a total dose of 70-74 Gy and concurrent weekly intravenous cisplatin (40 mg/m2). Results: The acute toxicities were all manageable. Grade 3-4 mucositis and skin reaction were seen in 6 patients (18%). RT interruption for a week occurred in 1 patient because of a Grade 3 dysphagia. All patients finished their planned RT. Four patients (12%) refused to complete the concurrent chemotherapy (CT) and 5 other patients (15%) did not receive the planned cycles of CT because of renal and/or hematologic toxicities. After a median follow-up of 58 months, 6 patients (18%) developed loco-regional relapse associated with distant metastasis in 4 cases (12%), and 6 patients (18%) developed distant metastases alone. Five-year overall survival and disease-free survival rates were 70 and 63%, respectively. A univariate analysis for prognostic factors was also performed. Overall survive was affected by Stage T4, Stage N3, age >40 years, and cycles of CT ≤ 5. Patients who received more than 5 cycles of cisplatin had also significantly better disease free survival and metastasis free survival. Conclusion: The results of our study have shown that CCRT for locoregionally advanced NPC is both feasible and effective, with acceptable toxic effects. On univariate analysis, the age >40 years, Stage T4, Stage N3, and cycles of CT ≤ 5 had a significantly poor outcome.