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• W2067854860 abstract "Purpose/Objective(s)The optimal fractionation schedule for nasopharyngeal carcinoma (NPC) involving the base of skull and intracranium is unknown. We found hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT) could achieve better local control and survival in NPC patients with T3 and T4 lesions at 3 year follow up. To confirm the effect of this approach, we analyzed more patients with long term follow up.Materials/MethodsFrom January 1992 to Dec 2003, 222 patients (74 T3 and 148 T4 NPC) were treated with hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT). HFRT was administered at 1.2 Gy per fraction, two fractions per day, Monday-Friday for 62 fractions for a total dose of 74.4 Gy. Concomitant chemotherapy consisting of cis-diamino-dichloroplatinum (CDDP) alone or CDDP and 5-fluorouracil were delivered simultaneously with radiotherapy during Weeks 1 and 6. Adjuvant chemotherapy consisted of CDDP and 5-fluorouracil for 2 to 3 cycles and was given monthly beginning 1 month after completion of radiation.ResultsWith a median follow-up of 102 months (range: 5 - 186 months), the 5-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 81.9%, 78.5%, 65.5% and 73.6%, respectively. At 10 years, the 10-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 76.7%, 75.5%, 60.5% and 64.2%, respectively. For T4 patients, the 10-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 73.0%, 70.5%, 53.0% and 58.4%, respectively. The major chronic toxicity was Grade 3/4 hearing impairment in 14% of patients. Brain necrosis rate is 2.3%.ConclusionsHFRT and CCT for T3 and T4 NPC were associated with good local control, survival and little treatment-related long term toxicity. But, the 10 year treatment result is suboptimal. To further improve the 10 year locoregional control rate for T4 NPC patients, we may consider using HFRT to give higher radiation dose up to 78 Gy with CCT in the IMRT era. Purpose/Objective(s)The optimal fractionation schedule for nasopharyngeal carcinoma (NPC) involving the base of skull and intracranium is unknown. We found hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT) could achieve better local control and survival in NPC patients with T3 and T4 lesions at 3 year follow up. To confirm the effect of this approach, we analyzed more patients with long term follow up. The optimal fractionation schedule for nasopharyngeal carcinoma (NPC) involving the base of skull and intracranium is unknown. We found hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT) could achieve better local control and survival in NPC patients with T3 and T4 lesions at 3 year follow up. To confirm the effect of this approach, we analyzed more patients with long term follow up. Materials/MethodsFrom January 1992 to Dec 2003, 222 patients (74 T3 and 148 T4 NPC) were treated with hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT). HFRT was administered at 1.2 Gy per fraction, two fractions per day, Monday-Friday for 62 fractions for a total dose of 74.4 Gy. Concomitant chemotherapy consisting of cis-diamino-dichloroplatinum (CDDP) alone or CDDP and 5-fluorouracil were delivered simultaneously with radiotherapy during Weeks 1 and 6. Adjuvant chemotherapy consisted of CDDP and 5-fluorouracil for 2 to 3 cycles and was given monthly beginning 1 month after completion of radiation. From January 1992 to Dec 2003, 222 patients (74 T3 and 148 T4 NPC) were treated with hyperfractionated radiotherapy (HFRT) and concomitant chemotherapy (CCT). HFRT was administered at 1.2 Gy per fraction, two fractions per day, Monday-Friday for 62 fractions for a total dose of 74.4 Gy. Concomitant chemotherapy consisting of cis-diamino-dichloroplatinum (CDDP) alone or CDDP and 5-fluorouracil were delivered simultaneously with radiotherapy during Weeks 1 and 6. Adjuvant chemotherapy consisted of CDDP and 5-fluorouracil for 2 to 3 cycles and was given monthly beginning 1 month after completion of radiation. ResultsWith a median follow-up of 102 months (range: 5 - 186 months), the 5-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 81.9%, 78.5%, 65.5% and 73.6%, respectively. At 10 years, the 10-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 76.7%, 75.5%, 60.5% and 64.2%, respectively. For T4 patients, the 10-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 73.0%, 70.5%, 53.0% and 58.4%, respectively. The major chronic toxicity was Grade 3/4 hearing impairment in 14% of patients. Brain necrosis rate is 2.3%. With a median follow-up of 102 months (range: 5 - 186 months), the 5-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 81.9%, 78.5%, 65.5% and 73.6%, respectively. At 10 years, the 10-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 76.7%, 75.5%, 60.5% and 64.2%, respectively. For T4 patients, the 10-year locoregional control rate, distant-metastasis free, disease-free and overall survivals were 73.0%, 70.5%, 53.0% and 58.4%, respectively. The major chronic toxicity was Grade 3/4 hearing impairment in 14% of patients. Brain necrosis rate is 2.3%. ConclusionsHFRT and CCT for T3 and T4 NPC were associated with good local control, survival and little treatment-related long term toxicity. But, the 10 year treatment result is suboptimal. To further improve the 10 year locoregional control rate for T4 NPC patients, we may consider using HFRT to give higher radiation dose up to 78 Gy with CCT in the IMRT era. HFRT and CCT for T3 and T4 NPC were associated with good local control, survival and little treatment-related long term toxicity. But, the 10 year treatment result is suboptimal. To further improve the 10 year locoregional control rate for T4 NPC patients, we may consider using HFRT to give higher radiation dose up to 78 Gy with CCT in the IMRT era." @default.
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• W2067854860 title "Long-term Results of Hyperfractionated Radiation Therapy and Concomitant Chemotherapy for T3 and T4 Nasopharyngeal Carcinoma" @default.
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