Experience Of Weekly Cisplatin Concurrent With Intensity-Modulated Radiotherapy For Locally Advanced Nasopharyngeal Carcinoma Patients With Resistance To Neoadjuvant Chemotherapy

Background: Nasopharyngeal carcinoma(NPC)is one of the most common head and neck malignant tumors in Southeast Asia and southern China.Radiation therapy(RT)is the preferred treatment.With the continuous improvement of radiotherapy technology,IMRT has become a standard radiation therapy in most areas?NPC is highly sensitive to chemotherapy,and cisplatin based chemotherapy is the most important chemotherapy.Neoadjuvant chemotherapy plus concurrent chemoradiotherapy(CCRT)is the appropriate treatment for locally advanced nasopharyngeal carcinoma(NPC)with extensive nodal disease and/or bulky tumors volume.However,a small proportion of patients are resistant to chemotherapy which is based on cisplatin.Making a valuable and relatively inexpensive schedule is necessary for these patients.Patients and methods: After completion of 2 cycles of neoadjuvant chemotherapy that consisted of gemcitabine and cisplatin(80mg/m2,every 3weeks)or Paclitaxel and cisplatin(80mg/m2,every 3 weeks),Before treatment and after 2 weeks of neoadjuvant chemotherapy,we evaluation of the efficacy with MRI.13 patients with extensive nodal disease or/and bulky tumors volume were determined SD and enrolled in this study.Cisplatin at a dose of 30 mg/m2 administered weekly concurrent with intensity-modulated radiotherapy(IMRT)was used to treat these patients with resistance to neoadjuvant chemotherapy.Results: After completion of CCRT,the overall tumor response was a complete response for 4/13(30.8%)patients,partial response for 9/13(69.2%)patients.The mean primary tumor volume was reduced 59.7% and 89.8% at the 24 th fraction of radiotherapy and after completion of radiotherapy,respectively.The mean nodal volume was reduced 63.8% and 93.5%,respectively.Conclusions: The study showed that weekly cisplatin concurrent with IMRT improve the therapeutic index for locally advanced NPC with resistance to neoadjuvant chemotherapy which is based on cisplatin.It was a valuable schedule for these patients.