Abstract
PurposeTo evaluate the outcomes of 255 patients with nasopharyngeal carcinoma (NPC) treated with four facio-cervical fields conformal radiotherapy (4F-CRT).ResultsIn one patient's 3 different RT treatment modalities, the 4F-CRT techniques resulted in sharper of the dose-volume histograms (DVHs) for primary gross tumor volume (PGTVnx) and planning target volume (PTVnx), similar to the intensity modulated radiation therapy (IMRT). The median follow-up duration was 43 months. Locoregional relapse and distant metastases as the first treatment failure events occurred in 32 (32/255, 12.5%) and 20 (30/255, 11.8%) patients, respectively. The 3-year and 5-year local control, disease-free survival, and overall survival rates were 83.3%, 82%, 83.8%, and 76.1%, 73.2%, 76.3% respectively. Univariate analysis displayed that clinical stage, T-stage, N-stage, and tumor response were related to prognosis. Multivariate analysis indicated that age, T-stage, N-stage, and combined chemotherapy were independent prognosticators. The incidence of grade 1–2 acute mucositis and leukocytopenia were 93.7% and 91.0%, respectively, with no cases of grade 4 toxicity detected.Materials and MethodsFrom November 2007 to December 2011, 255 patients with histologically diagnosed, non-metastatic NPC were enrolled into this study and received 4F-CRT. Magnetic resonance imaging scans of the nasopharynx were performed on every patient. All patients received definitive radiotherapy with 6 MV X-rays using conventional fractions at 2 Gy daily, 5 fractions per week, and 231 patients with stage IIb-IV received concurrent chemotherapy and cisplatin-based adjuvant chemotherapy. The accumulated survival was calculated according to the Kaplan-Meier method; the log-rank test was used to compare survival differences. Multivariate analysis was performed using Cox's proportional hazard model.ConclusionsCompared with the conventional treatment plans, the 4F-CRT plan delivered more dose to cover the tumor volume and reduces the doses of the normal tissues including the parotid gland, TMJs and so on. The long-term efficacy of 4F-CRT is satisfactory and its toxicities are tolerable.
Highlights
Nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in Southern China [1, 2].Owing to its anatomic location and high radiosensitivity, radiotherapy (RT) has long been as the preferred method of treatment for NPC
Univariate analysis displayed that clinical stage, T-stage, N-stage, and tumor response were related to prognosis
In order to overcome this difficulty, the author designed a method of the four facio-cervical fields conformal radiotherapy (4F-CRT) to treat patients with NPC [14] and applied this method in clinical practice according to the actual situation of the hospital
Summary
Nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in Southern China [1, 2].Owing to its anatomic location and high radiosensitivity, radiotherapy (RT) has long been as the preferred method of treatment for NPC. Conventional 2-dimensional radiotherapy (2D-RT) had been used as the most common method. Compared with 2D-RT and 3-dimensional radiotherapy (3D-CRT), IMRT improves the conformal dose covered the clinical target volume (CTV) in three dimensions, while protecting the normal tissues around the CTV. Published phase III studies indicated that IMRT has better curative effect and lower toxicity than with conventional 2D-RT or 3D-CRT [12, 13]. In order to overcome this difficulty, the author designed a method of the four facio-cervical fields conformal radiotherapy (4F-CRT) to treat patients with NPC [14] and applied this method in clinical practice according to the actual situation of the hospital. The purpose of our study was to analyze the long-term efficacy among 255 patients with NPC who received 4F-CRT in our hospital
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