ABSTRACT
Purpose@#This study was aimed to investigate long-term survivals and toxicities of early-stage nasopharyngeal carcinoma (NPC) in endemic area, evaluating the role of chemotherapy in stage II patients. @*Materials and Methods@#Totally 187 patients with newly diagnosed NPC and restaged American Joint Committee on Cancer/ International Union Against Cancer 8th T1-2N0-1M0 were retrospectively recruited. All received intensity-modulated radiotherapy (IMRT)±chemotherapy (CT) from 2001 to 2010. @*Results@#With 15.7-year median follow-up, 10-year locoregional recurrence-free survival, distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were 93.3%, 93.5%, 92.9% and 88.2%, respectively. Multivariable analyses showed cervical lymph nodes positive and pre-treatment prognostic nutritional index ≥ 52.0 could independently predict DMFS (p=0.036 and p=0.011), DSS (p=0.014 and p=0.026), and OS (p=0.002 and p 45 years (p=0.002) and pre-treatment lactate dehydrogenase ≥ 240 U/L (p 0.05). Unsurprising, patients in IMRT+CT had more acute gastrointestinal reaction, myelosuppression, mucositis, late ear toxicity, and cranial nerve injury (all p < 0.05) than IMRT alone group. @*Conclusion@#Superior tumor control and satisfying long-term outcomes could be achieved with IMRT in early-stage NPC with mild late toxicities. As CT would bring more toxicities, it should be carefully performed to stage II patients.
ABSTRACT
Objective To observe the safety and effectiveness of inductive chemotheray with lobaplatin plus 5-Fu (LF regimen) and concurrent chemoradiotherapy with lobaplatin for local-regionally advanced nasopharyngeal carcinoma (NPC) patients,and investigate the appropriate lobaplatin dose for the concurrent chemoradiotherapy.Methods Newly diagnosed local-regionally advanced NPC patients signed informed consent.The inductive chemotherapy was lobaplatin 30 mg/m2 + 5-Fu 4 g/m2 civ 120 h for 2 cycles every 21 days,then concurrent lobaplatin chemoradiotherapy was conducted.The initial lobaplatin dose for concurrent chemoradiotherapy was 50 mg/m2 with at least 3 cases in every dose level.If 2 of 3 patients presented dose-limiting toxicity (DLT),5 mg/m2 dose decreased for the next level until maximal tolerant dose (MTD) reached.The tumor response was evaluated after inductive chemotherapy,at the end of the chemoradiotherapy,3 months after chemoradiotherapy and 6 months after chemoradiotherapy.Results From Dec 2011 to Apr 2012,11 patients were enrolled in this study.After 2 courses of inductive chemoradiotherapy,CR,PR and SD were observed in 1,8 and 2 patients,respectively.At the end of the chemoradiotherapy and 3 months after chemoradiotherapy,CR and PR were observed in 10 and 1 patients,respectively.Six months after the chemoradiotherapy,all patients were CR.For the patients(3 in each arm) received 50 mg/m2 or 45 mg/m2 lobapaltin concurrent chemoradiotherapy,2 patients in each arm presented DLT.For the 5 patients received 40 mg/m2 lobapaltin concurrent chemoradiotherapy,no patients presented DLT.40 mg/m2 was suggested as the MTD.Inhibition of platelet was the major DLT.Conclusion Inductive chemotherapy with LF regimen and concurrent chemoradiotherapy with lobaplatin is safe and effective for local-regionally advanced NPC patients and the MTD of lobaplatin for the concurrent chemoradiotherapy is 40 mg/m2.Further clinical trial with large sample is expected.
ABSTRACT
ObjectiveTo compare the efficacy and side-effects in locally recurrent nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2DCRT).MethodsAmong the 292 newly diagnosed,nonmetastatic recurrent NPC,211were treated with IMRT and 81 with 2DCRT.All patients were staged according to the seventh edition of the UICC 2009 staging system.Kaplan-Meier and Logrank methods were used for survival analysis.A Cox proportional hazard model was used to examine prognostic factors.ResultsThe follow-up rate was 91.8％,there are 38 patients in 2DCRT and 106 patients in IMRT group was followed more than 3 years.There were significant differences in the 3-year actuarial overall survival (OS) rate ( 36.9％ and 51.3％,x2 =8.44,P =0.004) and local progression-free survival (LRFS) rate (63.3％ and 86.0％,x2 =13.83,P =0.000),and no significant differences in actuarial distant metastasis free survival rates (79.0％ and 83.5％,x2 =0.25,P=0.618 ) between the 2DCRT group and the IMRT group.Multivariate analysis showed that T category and IMRT ( yes vs.no) were the independently prognostic factors for OS and LRFS ( x2 =9.51,5.20,P =0.002,0.023 and x2 =4.84,9.24,P =0.027,0.002 ).The incidence of grade 3and4 trismus and radiation-induced encephalopathy were 19.9％,8.1％ for the IMRT group and 43.2％,24.7％ for the 2DCRT group ( x2 =16.37,P =0.000 and x2 =14.64,P =0.000).Whereas,severe mucosa necrosis and/or massive hemorrhage in the nasopharynx was observed in IMRT group which was not common in 2DCRT (33.2％∶7.4％,x2 =20.19,P=0.000).ConclusionsHigher local tumor control and overall survival were achieved by IMRT than 2DCRT,the incidence of severe trismus and radiation-induced encephalopathy was also reduced by IMRT,in cost of a higher incidence of mucosa necrosis and/or massive hemorrhage in the nasopharynx.