Clinical Research Papers:
Outcome and long-term efficacy of four facio-cervical fields conformal radiotherapy for nasopharyngeal carcinoma
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Wang Fangzheng1,2,*, Jiang Chuner3,*, Wang Lei1,2, Chen Weijun1,2, Xu Min1,2, Sun Quanquan1,2, Liu Tongxin1,2, Rihito Aizawa4, Masoto Sakamoto4, Fu Zhenfu1,2
1Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China
2Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China
3Department of Breast Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China
4Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan
*These authors have contributed equally to this work
Wang Fangzheng, email: [email protected]
Keywords: nasopharyngeal neoplasm, conformal radiotherapy, chemotherapy, efficacy, prognosis
Received: August 19, 2016 Accepted: December 27, 2016 Published: December 31, 2016
Purpose: To evaluate the outcomes of 255 patients with nasopharyngeal carcinoma (NPC) treated with four facio-cervical fields conformal radiotherapy (4F-CRT).
Results: In one patient’s 3 different RT treatment modalities, the 4F-CRT techniques resulted in sharper of the dose-volume histograms (DVHs) for primary gross tumor volume (PGTVnx) and planning target volume (PTVnx), similar to the intensity modulated radiation therapy (IMRT). The median follow-up duration was 43 months. Locoregional relapse and distant metastases as the first treatment failure events occurred in 32 (32/255, 12.5%) and 20 (30/255, 11.8%) patients, respectively. The 3-year and 5-year local control, disease-free survival, and overall survival rates were 83.3%, 82%, 83.8%, and 76.1%, 73.2%, 76.3% respectively. Univariate analysis displayed that clinical stage, T-stage, N-stage, and tumor response were related to prognosis. Multivariate analysis indicated that age, T-stage, N-stage, and combined chemotherapy were independent prognosticators. The incidence of grade 1–2 acute mucositis and leukocytopenia were 93.7% and 91.0%, respectively, with no cases of grade 4 toxicity detected.
Materials and Methods: From November 2007 to December 2011, 255 patients with histologically diagnosed, non-metastatic NPC were enrolled into this study and received 4F-CRT. Magnetic resonance imaging scans of the nasopharynx were performed on every patient. All patients received definitive radiotherapy with 6 MV X-rays using conventional fractions at 2 Gy daily, 5 fractions per week, and 231 patients with stage IIb-IV received concurrent chemotherapy and cisplatin-based adjuvant chemotherapy. The accumulated survival was calculated according to the Kaplan-Meier method; the log-rank test was used to compare survival differences. Multivariate analysis was performed using Cox’s proportional hazard model.
Conclusions: Compared with the conventional treatment plans, the 4F-CRT plan delivered more dose to cover the tumor volume and reduces the doses of the normal tissues including the parotid gland, TMJs and so on. The long-term efficacy of 4F-CRT is satisfactory and its toxicities are tolerable.
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