Clinical Research Papers:
Treatment outcomes and late toxicities of 869 patients with nasopharyngeal carcinoma treated with definitive intensity modulated radiation therapy: new insight into the value of total dose of cisplatin and radiation boost
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Xiaomin Ou1,2, Xin Zhou1,2, Qi Shi1,2, Xing Xing1,2, Youqi Yang1,2, Tingting Xu1,2, Chunying Shen1,2, Xiaoshen Wang1,2, Xiayun He1,2, Lin Kong1,2,3, Hongmei Ying1,2, Chaosu Hu1,2
1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
2Department of Oncology, Shanghai Medical College, Shanghai, China
3Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
Chaosu Hu, e-mail: [email protected]
Keywords: nasopharyngeal carcinoma, intensity-modulated radiation therapy, chemotherapy, radiation boost, late toxicity
Received: July 06, 2015 Accepted: August 22, 2015 Published: October 14, 2015
This study was to report the long-term outcomes and toxicities of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). From 2009 to 2010, 869 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. With a median follow-up of 54.3 months, the 5-year estimated local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were 89.7%, 94.5%, 85.6%, 76.3%, 84.0%, respectively. In locally advanced NPC, gender, T, N, total dose of cisplatin more than 300 mg/m2 and radiation boost were independent prognostic factors for DMFS and DFS. Age, T, N and total dose of cisplatin were independent prognostic factors for OS. Radiation boost was an adverse factor for LRFS, RRFS, DMFS and DFS. Concurrent chemotherapy was not an independent prognostic factor for survival, despite marginally significant for DMFS in univariate analysis. Concurrent chemotherapy increased xerostomia and trismus, while higher total dose of cisplatin increased xerostomia and otologic toxicities. In conclusion, IMRT provided satisfactory long-term outcome for NPC, with acceptable late toxicities. Total dose of cisplatin was a prognostic factor for distant metastasis and overall survival. The role of concurrent chemotherapy and radiation boost in the setting of IMRT warrants further investigation.
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