Şeyda TÜRKÖLMEZ, Dinçer YEĞEN, İclal ÇETİNDAĞ, Atiye Yılmaz ÖZSAVRAN, Karabekir ERCAN, Mehmet Faik CETİNDAĞ, Bülent YALÇIN

The results of nasopharyngeal cancer patients treated by simultaneous integrated boost technique and concomitant chemotherapy

Background/aim: To assess the efficacy and side effects of concurrent weekly chemotherapy and radiotherapy with simultaneousintegrated boost (SIB) technique for nasopharyngeal cancer (NPC).Materials and methods: A total of 51 consecutive patients with diagnosis of NPC were treated between February 2010 and December2015. The median dose for PTV70 (range: 60–82) was given in 33 fractions (range: 31–35). Forty-five of the patients received concomitantweekly chemotherapy between 3–7 cycles (median 6). Eleven patients received neoadjuvant and thirty-nine patients received adjuvantchemotherapy.Results: At a median follow-up 43 months (range: 2–76) the estimated 5-year overall survival and disease-free survival were 74.6% and62.6%, respectively.Conclusion: In radiotherapy of advanced NPC, generally a considerable amount of normal head and neck tissues might have to beirradiated in addition to gross tumor volume, involved node, and elective neck irradiation. Together with chemoradiotherapy, poor oralhygiene and inadequate nutritional support result in excessive morbidity. Despite loco-regional success of concurrent chemoradiotherapy,distant metastasis is still the major pattern of treatment failure in the intensity modulated radiotherapy era. We need to improve ouradjuvant chemotherapy regimens or develop new drugs.

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1. Regaud C. Lympho-épitheliome de l’hypopharynx traité par la roentgenthérapie. Bull Soc Franc Otorhinolaryngol 1921; 34: 209-214 (in French).
2. Lee, N, Riaz, N, Ove, R, Reyngold, ML, Foote, RL, Bonner, JA. Nasopharyngeal carcinoma. In: Gunderson LL, Tepper JE, editors. Clinical Radiation Oncology. 3rd ed. Philadelphia, PA, USA: Elsevier; 2012. pp. 619-638.
3. Lok BH, Setton J, Ho F, Riaz N, Rao SS, Lee NY. Nasopharynx. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady’s Principles and Practice of Radiation Oncology. 6th ed. Philadelphia, PA, USA: Wolters Kluwer/Lippincott Williams and Wilkins; 2013. pp. 730-760.
4. Turkoz FP, Celenkoglu G, Dogu GG, Kalender ME, Coskun U et al. Risk factors of nasopharyngeal carcinoma in Turkey – an epidemilogical survey of the Anatolian Society of Medical Oncology. Asian Pacific J Cancer Prevention 2011; 12: 3017- 3021.
5. Lin JC, Wang WY, Chen KY, Wei YH, Liang WM et al. Quantification of plasma Ebstein-Barr virus DNA in patients with advanced nasopharyngeal carcinoma. N Engl J Med 2004; 350: 2461-2470.
6. Neel HB, Pearson GR, Taylor WF. Antibodies to Epstein Barr virus in patients with nasopharyngeal carcinoma and in comparison groups. Ann Otol Rhinol Laryngol 1984; 93: 477- 482.
7. Hao SP, Tsang NM. Surgical management of recurrent nasopharyngeal carcinoma. Chang Gung Med J 2010; 33: 361- 368.
8. Emanuelli E, Albu S, Cazzador D, Pedruzzi B, Babighian G et al. Endoscopic surgery for recurrent undifferentiated nasopharyngeal carcinoma. J Craniofac Surg 2014; 25: 1003- 1008.
9. Jamshed A, Hussain R, İqbal H. Gemcitabine and cisplatin followed by chemo-radiation for advanced nasopharyngeal carcinoma. Asian Pacific Journal of Cancer Prevention 2014; 15: 899-904.
10. Liang ZG, Zhu XD, Tan AH, Jiang YM, Qu S et al. Induction chemotherapy followed by concurrent chemotherapy versus concurrent chemo radiotherapy with or without adjuvant chemotherapy for loco regionally advanced nasopharyngeal carcinoma: meta-analysis of 1,096 patients from 11 randomized controlled trials. Asian Pacific Journal of Cancer Prevention 2013; 14: 515-521.
11. Chi KH, Chang YC, Guo WY, Leung MJ, Shiau CY et al. A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients. Int J Radiation Oncology Biol Phys 2002; 52: 1238-1244.
12. Chua DT, Sham JS, Au GK, Choy D. Concomitant chemoirradiation for stage III-IV nasopharyngeal carcinoma in Chinese patients: results of a matched cohort analysis. Int J Radiat Oncol Biol Phys 2002; 53: 334-343.
13. Baujat B, Audry H, Bourhis J, Chan AT, Onat H et al. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys 2006; 64: 47-56.
14. Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J et al. Chemo-radiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase iii randomized intergroup study 0099. Journal of Clinical Oncology 1998; 16: 1310-1317.
15. Huncharek M, Kupelnick BA. Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma: results of a meta-analysis of 1528 patients from six randomized trials. American Journal of Clinical Oncology 2002; 25: 219-223.
16. Cheng JC, Chao KS, Low D. Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma. Int J Cancer 2001; 96: 126-131.
17. Han L, Lin SJ, Pan JJ, Chen CB, Zhang Y et al. Prognostic factors of 305 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. Chinese Journal of Cancer 2010; 29: 145-150.
18. Lee N, Xia P, Quivey JM, Sultanem K, Poon I et al. Intensitymodulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiation Oncology Biol Phys 2002; 53: 12-22.
19. Sun X, Su S, Chen C, Han F, Zhao C et al. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: an analysis of survival and treatment toxicities. Radiotherapy and Oncology 2014; 110: 398-403.
20. Lu TX, Mai WY, Teh BS, Zhao C, Han F et al. Initial experience using intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma. Int J Radiation Oncology Biol Phys 2004; 58: 682-687.
21. Peponi E, Glanzmann C, Kunz G, Renner C, Tomuschat K et al. Simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) in nasopharyngeal cancer. Strahlentherapie und Oncologie 2010; 3: 135-142.
22. Chen YK, Cheng RH, Chi KH, Liang JG, Wang SC et al. Application of 18F-FDG PET/CT in nasopharyngeal carcinoma. Ann Nucl Med Sci 2007; 20: 21-32.
23. Ng SH, Chang TC, Ko SF, Yen PS, Wan YL et al. Nasopharyngeal carcinoma: MRI and CT assessment. Neuroradiology 1997; 39: 741-746.
24. Lee AW, Ng WT, Chan LL, Hung WM, Chan CC et al. Evaluation of treatment for nasopharyngeal cancer – success and setback in the intensity-modulated radiotherapy era. Radiotherapy and Oncology 2014; 110: 377-384.