Outcome and long-term efficacy of four facio-cervical fields conformal radiotherapy for nasopharyngeal carcinoma

// Wang Fangzheng 1, 2, * , Jiang Chuner 3, * , Wang Lei 1, 2 , Chen Weijun 1, 2 , Xu Min 1, 2 , Sun Quanquan 1, 2 , Liu Tongxin 1, 2 , Rihito Aizawa 4 , Masoto Sakamoto 4 , Fu Zhenfu 1, 2 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China 2 Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China 3 Department of Breast Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China 4 Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan * These authors have contributed equally to this work Correspondence to: Wang Fangzheng, email: wangfz76@126.com Keywords: nasopharyngeal neoplasm, conformal radiotherapy, chemotherapy, efficacy, prognosis Received: August 19, 2016      Accepted: December 27, 2016      Published: December 31, 2016 ABSTRACT Purpose: To evaluate the outcomes of 255 patients with nasopharyngeal carcinoma (NPC) treated with four facio-cervical fields conformal radiotherapy (4F-CRT). Results: In 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 Methods: From 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. Conclusions: Compared 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.