ABSTRACT
Objective To investigate the therapeutic effect and side effects of concurrent chemotherapy and intensity-modulated radiotherapy (IMRT) following induction chemotherapy (IC) in patients with locally advanced nasopharyngeal carcinoma (NPC).Methods From January 2005 to January 2009,62 cases of locally advanced NPC confirmed by pathological and cytological examination received IC with vinorelbine (25 mg/m2) plus cisplatin (25 mg/m2) for 2-4 cycles and then concurrent chemotherapy and IMRT.Conventional fractionated radiotherapy was adopted in IMRT.The radiotherapy for the nasopharyngeal region was performed a dose of 72-76 Gy/36-38 fractions,and additional 5-Gy gammaknife treatment was carried out in case of local tumor residue.Prophylactic irradiation to the cervical lymph nodes was performed at a dose of 50 Gy,and the dose was increased to 60-70 Gy in case of lymph node enlargement.Results The follow-up rate was 100％.The patients showed a response rate (RR) of 89％ in the nasopharyngeal region and an RR of 90％ in the cervical lymph nodes.The 1-,2-,and 3-year overall survival rates,disease-free survival rates,local relapse-free survival rates,and distant metastasis-free survival rates were 97％,92％,and 82％,94％,73％,and 65％,97％,89％,and 87％,and 97％,84％,and 77％,respectively.The incidence rates of grade 3-4 acute reactions were 37％ for leucopenia,18％ for thrombocytopenia,and 6％ for mucositis.No grade 3-4 long-term temporomandibular joint injury and xerostomia were observed.Conclusions Concurrent chemotherapy and IMRT following IC with vinorelbine (25 mg/m2) plus cisplatin (25 mg/m2) have tolerable adverse effects and can achieve high survival rate in the patients with locally advanced NPC.