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Open Access Research

Concurrent image-guided intensity modulated radiotherapy and chemotherapy following neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

Pei-Wei Shueng14, Bing-Jie Shen1, Le-Jung Wu1, Li-Jen Liao2, Chi-Huang Hsiao3, Yu-Chin Lin3, Po-Wen Cheng2, Wu-Chia Lo2, Yee-Min Jen4 and Chen-Hsi Hsieh15*

Author Affiliations

1 Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan

2 Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan

3 Division of Medical Oncology and Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

4 Departments of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

5 Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

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Radiation Oncology 2011, 6:95  doi:10.1186/1748-717X-6-95

Published: 13 August 2011

Abstract

Background

To evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC).

Methods

Between August 2006 and December 2009, 28 patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction.

Results

After completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively.

Conclusion

HT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings.

Keywords:
Concurrent chemoradiation; Intensity-modulated radiotherapy; Helical tomotherapy; Nasopharyngeal carcinoma