Abstract
Nasopharyngeal carcinoma (NPC) is one of the most commonly diagnosed head and neck malignancies. This study investigated the outcome of locally advanced NPC patients on concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF). A total of 226 patients with locally advanced NPC received IMRT, with a total dose of 65-70 Gy and concurrent chemotherapy, with 2 cycles of TPF administered during radiotherapy, between March, 2005 and March, 2007. An additional 2 to 4 cycles of chemotherapy were administered every 21 days following radiotherapy. With a median follow-up time of 35 months (range, 7-60), the 5-year overall survival (OS) rate was 81.4%, with 93.6 and 75.0% for T3 and T4 lesions, respectively, (P=0.001). The 5-year progression-free survival (PFS) was 50.4%, with 66.7 and 46.9% for T3 and T4 lesions, respectively (P<0.001). T-classification was a significant prognostic factor for PFS and OS. The subgroup analysis revealed that pterygopalatine fossa invasion was associated with a significantly lower 5-year PFS (P=0.001) and OS (P=0.002), foramen rotundum invasion was associated with a significantly lower 5-year PFS (P<0.001) and OS (P=0.004), foramen ovale invasion was associated with a significantly lower 5-year PFS (P=0.013) and OS (P=0.024) and foramen lacerum and cavernous sinus invasion were associated with a significantly lower 5-year PFS (P<0.001 and P<0.001, respectively). Concurrent chemoradiotherapy is an advocated regimen for patients with locally advanced NPC, since it exhibits satisfactory 5-year PFS and OS rates. Our results suggest that the estimation of invasive range may identify a subgroup of patients with a higher risk of locoregional failure who may be better candidates for this treatment strategy.
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