Series Of Research About The Integrated Mode Of Chemoradiotherapy For Nasopharyngeal Carcinoma And The Salvage Treatment For The Recurrent Nasopharyngeal Carcinoma In Era Of Intensity Modulated Radiation Therapy

PART 1 LONG-TERM OUTCOMES OF NEOADJUVANT CHEMOTHERAPY FOLLOWED BY CONCURRENT CHEMORADIOTHERAPY VERSUS CONCURRENT CHEMORADIOTHERAPY ALONE FOR NASOPHARYNGEAL CARCINOMAPurpose Whether neoadjuvant chemotherapy(NCT)followed by concurrent chemoradiotherapy(CCRT)could improve the survival in nasopharyngeal carcinoma(NPC)remains controversial.This study explored the role of NCT for the treatment of NPC in era of intensity-modulated radiation therapy(IMRT).Methods A retrospective review was conducted of 255 NPC patients treated with NCT+CCRT(n=67)or CCRT alone(n=188)using IMRT between 2006.12 to 2012.12.To control the imbalance and bias between the two groups,a 1:2 match was performed using propensity score matching method(PSM)based on thepatient’s heterogeneity and chemotherapy regimens of CCRT.The long-term treatment outcomes and toxicity in NPC patients treated with NCT followed by CCRT(the NCT group,n=67)or concurrent chemotherapy(CCRT)alone(the CCRT group,n=134)after PSM was compared.Results With a median follow-up time was 49 months(11~105 months)for NCT group and 48 months(8~109 months)for CRT group,5-year overall survival(OS),progression free survival(PFS),recurrence free survival(RFS),local recurrence free survival(LRFS),regional recurrence free survival(RRFS)and distant failure free survival(DFFS)was 78.8%,69.1%,90.0%,90.0%,100% and 78.3% for NCT group,while 79.5%,75.7%,92.7%,94.2%,96.1% and 82.7% for CRT group,respectively(p=0.305,0.448,0.790,0.512,0.104 and 0.671).The multivariate analysis indicated that the effects of treatment(NCT vs.CRT)on patients’ OS,PFS,RFS,LRFS,RRFS and DFFS were not statistically significant(p=0.627,0.879,0.760,0.847,0.969 and 0.774,respectively)and showed that the patients who had completed at least two cycles of CRT got better OS,RFS and DFFS(p=0.009,0.016 and 0.043,respectively).There was no advantage of PF or TPF regimens compared to other neochemotherapy regimens such as docetaxel and nedaplatin(p=0.321,0.254,0.380 and 0.304 for OS,PFS,LRFS and DFFS,respectively).However,it showed no difference of incidences of any acute and most late toxicity between the NCT and CRT groups.Conclusions In conclusion,our study didn’t show the exact advantage or higher incidences of toxicity of NCT followed by CCRT compared with CCRT alone.However,in the era of IMRT,the role of NCT still need to be further explored.PART 2 TUMOR RECURRENCE AND RECURRENCE RISK FACTORS OF NASOPHARYNGEAL CARCINOMA AFTER INITIAL INTENSITY MODULATED RADIATION THERAPYPurpose The study was aimed at tumor control of nasopharyngeal cancer(NPC)after initial radical intensity modulated radiotherapy(IMRT),and trying to find out the recurrence risk factors to reduce the recurrence rate.Methods A retrospective review was conducted of 720 NPC patients newly proven by pathology without distant metastases and treated with radical IMRT between 2006.09 to 2012.09.Overall survival(OS),progression free survival(PFS),recurrence-free survival(RFS),local recurrence free survival(LRFS),regional recurrence free survival(RRFS)and distant failure free survival(DFFS)was examined.Moreover,recurrence survival and recurrence risk factors was analyzed.Results The median follow-up time of the whole cohort was 53 months(8~109months).5-year OS,PFS,RFS,LRFS,RRFS,DFFS was 79.9%,73.8%,91.4%,93.1%,96.7% and 85.8%,respectively in entire group.There were 60 relapse cases after initial radical IMRT,36 of local recurrence,12 of regional recurrence,10 of loco-regional recurrence,1 of local residual recurrence,1 of regional residual recurrence.Multifactor analysis results showed that age≥44years was the risk factor of local recurrence(p=0.030),while T-,N-andclinical stage weren’t(p>0.05).Conclusions It achieves really well tumor control of NPC after primary definitive IMRT,but there still exists mode of relapse failure,which was mainly seen in first three years.Our study showed taht older age was the risk factor for recurrence.How to reduce the recurrence rates for nasopharyngeal carcinoma(NPC)still need further study.PART 3 A PRELIMINARY STUDY ABOUT THE SAFETY AND EFFECTIVENESS OF SALVAGE INTENSITY MODULATED RADIATION THERAPY FOR RECURRENT NASOPHARYNGEAL CARCINOMA AFTER INITIAL RADICAL INTENSITY MODULATED RADIATION THERAPYPurpose The study was at evaluating the treatment safety,feasibility and effectiveness of salvage IMRT for recurrent nasopharygeal carcinoma after initial radiation.Methods A retrospective review was conducted of 23 recurrent NPC patients detailed on part two who accepted salvage IMRT.Overall survival(OS),progression free survival(PFS)and distant failure free survival(DFFS)was examined.Moreover,outcomes,complications and radiation parameters of salvage IMRT for recurrent NPC was calculated and analyzed.Results 22 cases had accomplished salvage IMRT as planned and 1-,2-year OS was 72.7% and 38.2%.The late sever complications of re-IMRT was nasopharyngeal bleeding and carotid artery bleeding.In this study,grade 3~4 toxicity reaction during salvage IMRT was not common.One patient gave up the salvage IMRT due to personal reasons after finishing radiation dose of 39.6 Gy and finally didn’t survival.Conclusions Salvage IMRT for recurrent NPC after radiation is safe,effective and feasible,but the long-term curative effect is poorer.How to increase the effect of salvage IMRT still need further study.