Clinical Study Of The Tumor Volume In The Modality Of Choice For Treatment Of Early Stage Nasopharyngeal Carcinoma

Objective:To study clinical value of the tumor volume in the modality of choice for treatment of early stage nasopharyngeal carcinoma.Method:From January 1 2005 to October 31 2006,sixty patients with nasopharyngeal carcinoma were proved pathologically and randomized into either the group of radiotherapy alone(control group,A group) or the concurrent chemoradiotherapy (treated group,B group).Each group consisted of thirty patients.According to the 1992 Fuzhou staging system,all patients had T_1-2N₁M₀.All patients underwent a CT simulation scan with contrast injection on the spiral CT scanner(GE) in the treatment position and immobilization in the radiotherapy department.The scope from the top of the head to below clavicles was scanned at 5-mm increments.The primary tumor volume in nasopharynx was localized on each CT image by more than two radiation oncologist and one radiologist and computed by treatment planning system.The patients in control group received only conventional radiotherapy.The dose of nasopharynx,upper neck,lower neck and superclavicular was 70Gy/35F/7W,66～70Gy/33～35F/6.5～7W,50～56 Gy/25～28F/5～5.5W,respectively.But the patients in treated group received chemoradiotherapy.The concurrent chemotherapy with PF(cisplatin,30mg/m²/d, on Days 1 to 3 and 5-fluorouracil,0.5g/m²/d on Days 1 to 3) was given every three week for three cycles from the first day of radiotherapy.Radiotherapy was administered with the same way in both group.Acute normal tissue effects were graded according to the Radiation Therapy Ontology Group(RTOG) and LENT SOMA radiation morbidity scoring criteria.Results:All patients completed planned doses of radiotherapy and thirty patients in the treatment group completed planned chemotherapy.60 patients were eligible for toxicity and response analysis.After a median follow-up of 16 months,the complete response rates were 96.7%for A group and 80.0%for B group (X²=4.043,P=0.044),there was a significant difference in complete response in favor of the B group.Acute skin toxicity rates in these two guoups were 90%and 80%in grade 1～2 and 10%and 20%in grade 3～4(X²=1.176,P=0.278), respectively.Accordingly,the acute mucositis rates were 83.3%and 66.7%in grade 1～2 and 16.7%and 33.3%in grade 3～4(X²=2.222,P=0.136),respectively. The lack of high-grade toxicity was observed.Conclutions:Chemoradiotherapy was feasible with the gross tumor volume more than 25cm³ for early stage nasopharyngeal carcinoma.Initial results showed good complete response and local control.The remote local control rate and survival rate await further follow-up.The severe late complications also have to be following up.