DOI QR코드

DOI QR Code

Simultaneous Modulated Accelerated Radiation Therapy and Concurrent Weekly Paclitaxel in the Treatment of Locally Advanced Nasopharyngeal Carcinoma

  • Xie, Cong-Ying (Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College) ;
  • Jin, Xian-Ce (Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College) ;
  • Deng, Xia (Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College) ;
  • Xue, Sheng-Liu (Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College) ;
  • Jing, Zhao (Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College) ;
  • Su, Hua-Fang (Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College) ;
  • Wu, Shi-Xiu (Department of Radiotherapy and Chemotherapy, the 1st Affiliated Hospital of Wenzhou Medical College)
  • Published : 2012.12.31

Abstract

Objectives: To evaluate the feasibility and efficacy of simultaneous accelerated radiation therapy (SMART) and concurrent weekly paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma. Methods: Forty-one patients with pathologically confirmed nasopharyngeal carcinoma were treated by SMART with concurrent weekly paclitaxel. Daily fraction doses of 2.5 Gy and 2.0 Gy were prescribed to the gross tumor volume (GTV) and clinical target volume (CTV) to a total dose of 70 Gy and 56 Gy, respectively. Paclitaxel of $45mg/m^2$ was administered concurrently with radiation therapy every week. Adjuvant chemotherapy was given four weeks after the completion of the radiotherapy (RT) if the tumor demonstrated only a partial response (PR). Results: All patients completed the radiotherapy (RT) course. Adjuvant chemotherapy was administered to 12 patients due to PR. The CR (complete remission) rate was 82.9% three months after RT. Thirty-nine (95.1%) patients completed the concurrent weekly chemotherapy with paclitaxel, and two patients skipped their sixth course. Seven patients had a 15% dosage reduction at the fifth and sixth course due to grade 3 mucositis. The median follow-up was 30 (range, 14-42) months. The three-year overall survival (OS), metastases-free survival (MFS), and local control rates were 77.0%, 64.4%, and 97.6%, respectively. No correlation between survival rate and T or N stage was observed. Grade 3 acute mucositis and xerostomia were present in 17.1% and 7.1%, respectively. Conclusion: SMART with concurrent weekly paclitaxel is a potentially effective and toxicity tolerable approach in the treatment of locally advanced NPC.

Keywords

Nasopharyngeal carcinoma;SMART;concurrent chemotherapy;paclitaxel

References

  1. Kwong DL, Sham JS, Leung LH, et al (2006). Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys, 64, 374-81. https://doi.org/10.1016/j.ijrobp.2005.07.968
  2. Lee AW, Lau WH, Tung SY, et al (2005). Preliminary results of a randomized study on therapeutic gain by concurrent chemoradiotherapy for regionally-advanced nasopharyngeal carcinoma. NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol, 23, 6966-75. https://doi.org/10.1200/JCO.2004.00.7542
  3. Lee N, Harris J, Garden AS, et al (2009). Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. J Clin Oncol, 27, 3684-90. https://doi.org/10.1200/JCO.2008.19.9109
  4. Lee N, Xia P, Quivey JM, et al (2002). Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys, 53, 12-22. https://doi.org/10.1016/S0360-3016(02)02724-4
  5. Lin JC, Jan JS, Hsu CY, et al (2003). Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol, 21, 631-7. https://doi.org/10.1200/JCO.2003.06.158
  6. Pow EH, Kwong DL, McMillan AS, et al (2006). Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys, 66, 981-91. https://doi.org/10.1016/j.ijrobp.2006.06.013
  7. Tham IWK, Hee SW, Yeo RMC, et al (2009). Treatment of nasopharyngeal carcinoma using intensity modulated radiotherapy - the National Cancer Center Singapore experience. Int J Radiat Oncol Biol Phys, 75, 1481-6. https://doi.org/10.1016/j.ijrobp.2009.01.018
  8. Trotti A, Colevas AD, Setser A, et al (2003). CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol, 13, 176-81. https://doi.org/10.1016/S1053-4296(03)00031-6
  9. Wee J, Tan EH, Tai BC, et al (2005). Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol, 23, 6730-8. https://doi.org/10.1200/JCO.2005.16.790
  10. Wolden SL, Chen WC, Pfister DG, et al (2006). Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys, 64, 57-62. https://doi.org/10.1016/j.ijrobp.2005.03.057
  11. Wu S, Xie C, Jin X, et al (2006). Simultaneous modulated accelerated radiation therapy in the treatment of nasopharyngeal cancer: a local center's experience. Int J Radiation Oncology Biol Phys, 66, S40-6.
  12. Baujat B, Audry H, Bourhis J, et al (2006). 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, 64, 47-56. https://doi.org/10.1016/j.ijrobp.2005.06.037
  13. Bowman GP, Hodson DI, Mackenzie RJ, et a1 (2001). Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer. A systematic review of the published literature with subgroup analysis. Head Neck, 23, 579-89. https://doi.org/10.1002/hed.1081
  14. Butler EB, The BS, Grant WH 3rd, et al (1999). Smart (simultaneous modulated accelerated radiation therapy) boost: a new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. Int J Raditat Oncol Biol Phys, 45, 21-32. https://doi.org/10.1016/S0360-3016(99)00101-7
  15. Chen M, Wu SX, Chen YY, et al (2004). Radiation therapy concurrent with weekly paclitaxel for locoregionally advanced nasopharyngeal carcinoma: outcomes of a phase I trial. Am J Clin Oncol, 27, 481-4. https://doi.org/10.1097/01.coc.0000135180.94470.45
  16. Chen Y, Liu MZ, Liang SB, et al (2008). Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of China. Int J Radiat Oncol Biol Phys, 71, 1356-64. https://doi.org/10.1016/j.ijrobp.2007.12.028
  17. Fang FM, Chien CY, Tsai WL, et al (2008). Quality of life and survival outcome for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy-a longitudinal study. Int J Radiat Oncol Biol Phys, 72, 356-64. https://doi.org/10.1016/j.ijrobp.2007.12.054
  18. Forastiere AA, Shank D, Neuberg D, et al (1998). Final report of a phase II evaluation of paclitaxel in patients with advanced squamous cell carcinoma of the head and neck, an Eastern Cooperative Oncology Group trial(PA390). Cancer, 82, 2270-4. https://doi.org/10.1002/(SICI)1097-0142(19980601)82:11<2270::AID-CNCR24>3.0.CO;2-Q
  19. Huncharek M, Kupelnick B (2002). Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma results of a meta-analysis of 1,528 patients from six randomized trials. Am J Clin Oncol, 25, 219-23. https://doi.org/10.1097/00000421-200206000-00002
  20. Kam MK, Leung SF, Zee B, et al (2007). Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol, 25, 4873-9. https://doi.org/10.1200/JCO.2007.11.5501
  21. Kam MK, Teo PM, Chau RM, et al (2004). Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys, 60, 1440-50. https://doi.org/10.1016/j.ijrobp.2004.05.022