gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Long-term results of chemoradiation therapy with photons/protons for locally advanced nasopharyngeal carcinoma

Meeting Abstract

  • S. Bolle - Centre de Protontherapie de l'Institut Curie, Orsay, France
  • A. Levy - Radiation Oncology Department, Hopital de la Pitie Salpetriere, Paris, France
  • V. Calugaru - Centre de Protontherapie de l'Institut Curie, Orsay, France
  • L. Feuvret - Centre de Protontherapie de l'Institut Curie, Orsay, France
  • J.-L. Habrand - Centre de Protontherapie de l'Institut Curie, Orsay, France
  • G. Noel - Radiation Oncology Department, Centre Paul Strauss, Strasbourg, France

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog022

doi: 10.3205/09ptcog022, urn:nbn:de:0183-09ptcog0228

Veröffentlicht: 24. September 2009

© 2009 Bolle et al.
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Purpose: Retrospective study of treatment outcome in patients with locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation using a combination of photons and protons

Material and methods: Between 1999 and 2003, 13 patients with a median age of 40 years presenting T4N0M0 or T4N1M0 (TNM –UICC 1997) nasopharyngeal carcinoma received chemoradiation therapy with a combination of photons and protons radiation therapy. 54% received platin-based neoadjuvant chemotherapy. All patients were treated with concurrent platin-based chemoradiation with a prophylactic dose of 44 Gy to uninvolved cervical node area and the nasopharynx followed by a boost to a median dose of 71 CGE (70–78 CGE) to the primary tumour with fraction of 1.8–2 CGE . The median dose delivered with photons was 44 CGE (40–54 CGE) and 28 CGE (18–38 CGE) with protons. Amifostine was administrated to 7/13 patients to prevent xerostomia.

Results: The median follow-up was 59 months (5–80 months). Treatment was well tolerated and no patient presented severe acute toxicity requiring definitive interruption of the radiation therapy. 62% of the patients received all three planned concurrent chemotherapy cycles.

Tumour recurred locally in 1 patient at 47 months. No patient developed neck recurrence. Distant metastasis occurred in 3 patients. Lung was the main site of distant metastasis.

The disease-free and overall survival rates were 92%/92% at 5 years and, 67% and 77% respectively at 10 years.

Grade 5 digestive hemorrage occurred in one patient 5 months after treatment. However relationship with chemoradiation therapy was uncertain because of existing co-morbidities. Grade 3 late toxicity consisted in otoxicity in 2 patients. No patient presented grade 3 xerostomia. Six patients presented cerebral radiation necrosis diagnosed on systematic follow-up MRI. Only one was symptomatic. In this patient, radiological abnormalities regressed after medical treatment. Other grade 1-2 long term side effects included otoxicity, trismus, endocrine deficit, visual toxicity, arterial stenosis and nerve palsy. One patient presented several years after protontherapy an uncomplicated pregnancy.

Conclusion: High-dose photons/protons radiation therapy with concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma is feasible with acceptable grade 3 or more toxicity and results in good long term local control. However particular attention is required to limit the irradiated volume of cerebral parenchyma in patients receiving high dose radiation with concomittant chemotherapy.