Feasibility and efficiency of concurrent chemo-radiotherapy for nasopharyngeal carcinoma patients

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Feasibility and efficiency of concurrent chemo-radiotherapy for nasopharyngeal carcinoma patients By :Galuh Tiara Akbar, S.KedMuhammad Maliki S.KedNur Islah Agusti S.KedRanti Purnama Sari S.KedSepnita Usman S.KedTrigen Rahmat Yulis S.KedAdvicer :Dr. Ariman Syukri, Sp.THT-KLDr. Asmawati, Sp.THT-KLDr. Harianto, Sp.THT-KL

BACKGROUND The aim of this retrospective study is to evaluate the feasibility and efficiency of CCRT in loco regionally advanced NPC patients. PATIENTS AND METHODS Patient characteristics

Treatment plan: Patient evaluation and follow-up Statistical methods: The Log-rank test was used to compare the curves and p-values < 0.05 were considered to be statistically significant. RESULTSToxicity :

:Events and survivalAfter a median follow-up of 58 months (range, 3-94 months)6 patients (18%) developed loco-regional relapse associated with distant metastasis in 4 cases (12%)6 patients (18%) developed distant metastases alone

Overall survival (OS) 70%Disease-free survival (DFS) 63%Loco-regional relapse-free survival (LRRFS) 80%Metastasis relapse-free survival (MRFS) 68%Overall survival

Disease-free survival (DFS)

Loco-regional relapse-free survival (LRRFS)

Metastasis relapse-free survival (MRFS)Prognostic factors:DISCUSSIONCONCLUSIONOur study confirms that weekly cisplatin concurrent with RT for locally advanced nasopharyngeal cancers was found tolerable with a high efficiency and provides further evidence on the prognostic significance of CT dosing during the concurrent phase with RT.REFERENCES1. Boussen H, Bouaouina N, Gamoudi A, Mokni N, Benna F, Boussen I, Ladgham A. EMC oto-rhino-laryngologie : Cancers du nasopharynx. Elsevier Masson, 2007. 2. Altun M, Fandi A, Dupuis O, et al: Undifferentiated nasopharyngeal cancer (UCNT): Current diagnostic and therapeutic aspects. Int J RadiatOncolBiol Phys. 1995; 32:859-77. 3. Registre des cancers Nord-Tunisie. Donnes 1999-2003. Evolution 1994-2003. Projections lhorizon 2024. 4. Yeh SA, Tang Y, Lui CC, Huang YJ, Huang EY. Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J RadiatOncolBiol Phys. 2005;62:672-9. 5. Lee AW, Poon YF, Foo W, Law SC, Cheung FK, Chan DK, Tung SY, Thaw M, Ho JH. Retrospectiveanalysis of 5037 patients with nasopharyngealcarcinoma treated during 1976-1985:Overall survival and patterns of failure. Int JRadiatOncolBiol Phys. 1992; 23:261-270, 6.6. Teo P, Yu P, Lee WY, Leung SF, Kwan WH, Yu KH, Choi P, Johnson PJ. Significant prognostic factorsafter primary radiotherapy in 903 non-disseminated nasopharyngealcarcinoma evaluated by computed tomography.Int J RadiatOncolBiol Phys. 1996;36:291-304. 7. Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF.Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J ClinOncol. 1998;16:1310-7. 8. Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY.Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J ClinOncol. 2003;2:631-7. 9. Kwong DL, Sham JS, Au GK, Chua DT, Kwong PW, Cheng AC, Wu PM, Law MW, Kwok CC, Yau CC, Wan KY, Chan RT, Choy DD.Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J ClinOncol. 2004;22:2643-53. 10. Chan AT, Leung SF, Ngan RK, Teo PM, Lau WH, Kwan WH, Hui EP, Yiu HY, Yeo W, Cheung FY, Yu KH, Chiu KW, Chan DT, Mok TS, Yau S, Yuen KT, Mo FK, Lai MM, Ma BB, Kam MK, Leung TW, Johnson PJ, Choi PH, Zee BC.Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005;97:536-9. 11. Lee AW, Lau WH, Tung SY, Chua DT, Chappell R, Xu L, Siu L, Sze WM, Leung TW, Sham JS, Ngan RK, Law SC, Yau TK, Au JS, O'Sullivan B, Pang ES, O SK, Au GK, Lau JT; Hong Kong Nasopharyngeal Cancer Study Group. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J ClinOncol. 2005;23:6966-75. 12. Chua DT, Ma J, Sham JS, Mai HQ, Choy DT, Hong MH, Lu TX, Min HQ. Long-term survival after cisplatin-based induction chemotherapy and radiotherapy for nasopharyngeal carcinoma: a pooled data analysis of two phase III trials.J ClinOncol. 2005;23:1118-24. 13. Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, Chua ET, Yang E, Lee KM, Fong KW, Tan HS, Lee KS, Loong S, Sethi V, Chua EJ, Machin D. 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 ClinOncol. 2005;23:6730-8. 14. Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O'Sullivan B, Yau TK, Leung TW, Au JS, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH. J Natl Cancer Inst. 2010;102:1188-98. 15. Lee AW, Tung SY, Chan AT, Chappell R, Fu YT, Lu TX, Tan T, Chua DT, O'sullivan B, Xu SL, Pang ES, Sze WM, Leung TW, Kwan WH, Chan PT, Liu XF, Tan EH, Sham JS, Siu L, Lau WH.Preliminary results of a randomized study (NPC-9902 Trial) on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma. Int J RadiatOncolBiol Phys. 2006;66:142-51.THANK YOU