Abstract:
Objective This study aims to report a monoinstitutional experience with the use of intensity-modulated radiotherapy (IMRT)for nasopharyngeal carcinoma (NPC).
Methods Between June 2006 and December 2010, 339 consecutive histology-proven NPC patients treated with IMRT had a median follow-up of 22.5 months. The effects of multiple clinical and treatment parameters on the evaluated survival parameters were determined.
Results A total of 339 patients with NPC treated with IMRT were included, among which 244 were males and 95 were females (gender ratio, 2.57:1), with a median age of 44 years (range, 13 to 78 years). According to the AJCC/UICC 2010 classification, 76.1% of the patients had Stage Ⅲ/Ⅳ disease. The 1-, 2- and 3-year overall survival (OS) was 99.0%, 94.9%, 90.7%, disease-specific survival (DSS) was 99.1%, 97.0%, 94.2%, disease-free survival (DFS) was 96.4%, 92.9%, 86.4%, local control was 98.1%, 96.5%, 95.7%, regional control was 99.3%, 98.5%, 97.8%, and metastasis-free survival (MFS) was 97.1%, 93.6%, 88.1%, Through Cox multivariate analysis, the age (< 44 years vs. ≥44 years) and the clinical stage (Ⅰ to Ⅲ vs. Ⅳ) were found to have predictive values for OS, DFS, and MFS, whereas the late clinical stage (IVA to IVB) was found to be the independent predictor of poor DSS. The most common acute toxicities included Grades Ⅰ to Ⅱ skin reaction in 335 patients (98.8%) and Grades Ⅱ to Ⅲ oral mucositis in 322 patients (95.0%). After 2 years of IMRT, 12 patients had GradesⅠ toⅡ xerostomia (10.4%). No Grades Ⅲ or IV xerostomia was detected.
Conclusions The use of IMRT is associated with excellent loco-regional control and overall survival. Acute toxicity is common and acceptable. Distant metastasis remains the most difficult challenge, and more effective systemic regimens should be tailored for patients with high risk factors.