Abstract
The long-term efficacy of microwave hyperthermia combined with chemoradiotherapy in treating nasopharyngeal carcinoma (NPC) with metastatic foci in cervical lymph nodes was evaluated. A total of 154 cases of N2 or N3 stage NPC were randomized into two groups: hyperthermia group (76 cases) and control group (78 cases). Both received cisplatin chemotherapy and radiotherapy. In addition, the hyperthermia group further received microwave hyperthermia to the metastatic cervical nodes with different patterns (before or after radiotherapy), heating temperatures (T90 < 43° and T90 ≥ 43°) and hyperthermia episodes (< 4 times, 4-10 times and > 10 times). The 3-month and 5-year complete response (CR) rates of cervical lymph nodes in the hyperthermia group were significantly higher than those in the control group. The 5-year disease-free survival (DFS) rate and the 3-year / 5-year overall survival rate in the hyperthermia group were also significantly higher. There was no significant difference in 5-year metastatic rates. In the hyperthermia group, the 3-month and 5-year CR rates of T90 < 43° treatment were significantly lower than with T90 ≥ 43° treatment. The CR rate was highest when the hyperthermia was performed 4-10 times. There were no significant differences in 3-month and 5-year CR rates between hyperthermia before or after radiotherapy treatment. Microwave hyperthermia combined with chemoradiotherapy can increase local control, DFS and 3, 5-year overall survival rates of patients with N2 ~ N3 stage NPC. The heating temperature should be over 43° with hyperthermia repeated 4-10 times.
Highlights
Nasopharyngeal carcinoma (NPC) is a unique type of head and neck cancer in terms of epidemiology, method of treatment and prognosis, and is prevalent in Southeast Asia (Roychowdhury et al, 1996; Erkal et al, 2001; Liu et al, 2003)
Patient Selection Patients who fulfilled all of the following criteria were enrolled in this study: (1) nasopharyngeal carcinoma (NPC) confirmed by biopsy and histology; (2) no evidence of distant metastasis; (3) no previous treatment for NPC; (4) T1-4N2-3M0 disease according to the staging system of the 2002 American Joint Committee on Cancer (AJCC) / International Union Against Cancer (UICC) (Fleming et al, 1997); (5) adequate liver function; (6) adequate renal function; (7) adequate bone marrow function; and (8) Karnofsky performance status (KPS) ≥80
The skin reaction was severe in hyperthermia group but without statistically significant difference (P > 0.05)
Summary
Nasopharyngeal carcinoma (NPC) is a unique type of head and neck cancer in terms of epidemiology, method of treatment and prognosis, and is prevalent in Southeast Asia (Roychowdhury et al, 1996; Erkal et al, 2001; Liu et al, 2003). The incidence of cervical lymph node metastasis in nasopharyngeal cancer (NPC) is high. Some enlarged cervical lymph nodes still exist in NPC patients. The toxicity of chemotherapy drugs on unheated normal tissues can be reduced, which will help prevent or delay the drug resistance. It is shown by a number of clinical trials that the efficacy of combined treatment including hyperthermia, radiotherapy and chemotherapy were better than the efficacy of each therapy alone (Song et al, 2006; Chen et al, 2009). The long-term effect of hyperthermia in combination with radiotherapy and chemotherapy on NPC patients with cervical lymph node metastasis was investigated.
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