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IMRT plus chemotherapy offers high locoregional control in advanced nasopharyngeal carcinoma

Sat, Jul 13, 2013

Oral Cancer News


Treatment with intensity-modulated radiotherapy and concurrent weekly chemotherapy improved xerostomia and dysphagia in patients with advanced nasopharyngeal carcinoma, according to study results presented at the WIN Symposium.

Researchers in China recruited 310 patients with stages III to IVb nasopharyngeal carcinoma. All patients received curative IMRT plus weekly chemotherapy with cisplatin (40 mg/m2). Patients received doses of 66 to 70.4 Gy to the gross tumor volume, 60 Gy to the first clinical target, and 54 to 56 Gy to the second clinical target.

“The medial group retropharyngeal nodes were never contoured as clinical target volume, aiming to spare the pharyngeal constrictors unless they were involved,” the researchers wrote. “[The] level 1b node was selectively contoured as clinical target volume in order to spare the submandibular glands and oral cavity.”

Patient-reported and observer-related scores assessed swallowing and salivary gland function at baseline and periodically up to 3 years after treatment.

Median follow-up was 39 months. At 3 years, researchers reported a local RFS rate of 93.6%, a regional RFS rate of 95.8% and a distant metastases-free survival rate of 80%.

Researchers reported no marginal or out-of-field relapses.

Patients’ dysphagia and xerostomia worsened during late courses of treatment, as well as after treatment, yet scores gradually improved after therapy. Dysphagia was minimal or absent at 9 months post radiotherapy, whereas xerostomia improved from 3 to 15 months post radiotherapy and remained steadily until the conclusion of follow-up.

“IMRT concurrent with weekly chemotherapy aiming to reduce xerostomia and dysphagia can be safely performed for locally advanced [nasopharyngeal carcinoma] and has high locoregional control rates,” researchers wrote. “Distant metastasis remains the main failure pattern. Long-term patient-reported and observer-rated swallowing and salivary glands function were only slightly worse than baseline.”

1. Wang XS. Abstract #P6.17. Presented at: WIN Symposium; July 10-12, 2013; Paris.

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