Abstract
Objective. The 5-year clinical outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT) were evaluated. Methods. Six hundred ninety five NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from January, 2003 to December, 2006 were analyzed retrospectively, including 540 males and 155 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67–76 Gy in 30–33 fractions, positive neck lymph nodes (GTVln-R/L) 60–70 Gy in 30–33 fractions, high-risk clinical target volume (CTV1) 60–66 Gy, low-risk clinical target volume (CTV2) 54–60 Gy, and clinical target volume of cervical lymph node regions (CTVln) 50–55 Gy. Results. The 5-year local control (LC), regional control, distant metastasis-free survival (DMFS), disease free survival, disease specific survival, and overall survival (OS) rates were 89.8%, 95.2%, 74.1%, 69.6%, 83.2%, and 77.1%. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 72.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2%, respectively. Conclusion. The 5-year LC and OS rate of NPC treated with IMRT was 89.8% and 77.1%. The clinical stage, N stage, volume of GTVnx, and chemotherapy were the main prognostic factor for the OS. Distant metastasis was the main pattern of failure.
Highlights
Nasopharyngeal carcinoma (NPC) is common among Asians, especially the Southern Chinese, with an incidence rate as high as 30–50 cases/100,000 people
The dose coverage and uniformity by Intensity-modulated radiotherapy (IMRT) were excellent, for some T3 and T4 patients underdosing a small part of target volumes was inevitable because of the close proximity of critical neurologic structures
Of the 480 patients with stage III/IV carcinomas, 21 received IMRT alone, and 459 received IMRT combined with chemotherapy
Summary
Nasopharyngeal carcinoma (NPC) is common among Asians, especially the Southern Chinese, with an incidence rate as high as 30–50 cases/100,000 people. Intensity-modulated radiotherapy (IMRT) is a major breakthrough in the treatment of nasopharyngeal carcinoma (NPC). It is capable of producing highly conformal dose distributions with steep dose gradients and complex isodose surfaces. Zhao et al [14] have reported the results of IMRT treatment in 139 cases of NPC at the Sun Yat-Sen Cancer Center; the 3-year locoregional progression-free survival (LPFS), DMFS, and OS rates were 94.5%, 91.0%, and 86.6%, respectively. Most of the patients exhibited only grades 1-2 acute radiation reactions and grades 0-1 late damage; none of the patients exhibited grade 4 acute reactions or late damage Taken together, these reports have shown that IMRT technology has incomparable advantages. Data from large-scale, long-term follow-up studies are still
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