Long-term results of concurrent chemoradiotherapy for T3/T4 locally advanced nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is one of the most commonly diagnosed head and neck malignancies. This study investigated the outcome of locally advanced NPC patients on concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF). A total of 226 patients with locally advanced NPC received IMRT, with a total dose of 65-70 Gy and concurrent chemotherapy, with 2 cycles of TPF administered during radiotherapy, between March, 2005 and March, 2007. An additional 2 to 4 cycles of chemotherapy were administered every 21 days following radiotherapy. With a median follow-up time of 35 months (range, 7-60), the 5-year overall survival (OS) rate was 81.4%, with 93.6 and 75.0% for T3 and T4 lesions, respectively, (P=0.001). The 5-year progression-free survival (PFS) was 50.4%, with 66.7 and 46.9% for T3 and T4 lesions, respectively (P<0.001). T-classification was a significant prognostic factor for PFS and OS. The subgroup analysis revealed that pterygopalatine fossa invasion was associated with a significantly lower 5-year PFS (P=0.001) and OS (P=0.002), foramen rotundum invasion was associated with a significantly lower 5-year PFS (P<0.001) and OS (P=0.004), foramen ovale invasion was associated with a significantly lower 5-year PFS (P=0.013) and OS (P=0.024) and foramen lacerum and cavernous sinus invasion were associated with a significantly lower 5-year PFS (P<0.001 and P<0.001, respectively). Concurrent chemoradiotherapy is an advocated regimen for patients with locally advanced NPC, since it exhibits satisfactory 5-year PFS and OS rates. Our results suggest that the estimation of invasive range may identify a subgroup of patients with a higher risk of locoregional failure who may be better candidates for this treatment strategy.