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Background and Objective: Induction chemotherapy and radiotherapy or concurrent chemoradiotherapy are the most two effective treatments for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). This study was to compare the efficacy of induction-concurrent chemoradiotherapy versus induction chemotherapy and radiotherapy for patients with locoregionally advanced NPC. Methods: From August 2002 to April 2005, 408 patients were randomly divided into the induction-concurrent chemoradiotherapy (IC/CCRT) group and the induction chemotherapy and radiotherapy (IC/RT) group. Patients in both groups received the same induction chemotherapy, including two cycles of floxuridine (FuDR) plus carboplatin (FuDR 750mg/m^2, d1-5; carboplatin AUC=6). All the patients underwent radiotherapy one week after completing the induction chemotherapy. The patients in the IC/CCRT group also received carboplatin (AUC=6) on day 7, 28, and 49 during radiotherapy. Eight patients did not meet the inclusion criteria and were excluded. The remaining 400 cases were analyzed. Results: Grade Ⅲ/Ⅳ toxicity was found in 28.4% of the patients in the IC/CCRT group and 13.1% in the IC/RT group (P＜0.001). After a median follow up time of 3.9 years, the three-year overall survival was 75.9% and 83.4% (P=0.12) in the IC/CCRT and IC/RT groups, respectively. No significant differences in the failure-free survival rate, the locoregional control rate, and the distant control rate were found between the two groups. Conclusion: The IC/CCRT program does not improve the overall survival rate in patients with locoregionally advanced NPC compared with the IC/RT program.

Although intracavitary irradiation (ICI) is usually applied to enhance dose in radiotherapy for early stage nasopharyngeal carcinoma (NPC), its use in parapharyngeal enhancing dose is limited because of dislocation and poor repetition of conventional catheterization. This study was to evaluate the application of a new technique, interstitial brachytherapy via parapharynx involvement transnasal approach, to enhance dose in radiotherapy for NPC.Twenty-three naive and recurrent NPC patients with tumor residue of more than 1 cm under nasopharyngeal mucosa or restricted tumor residue in the parapharyngeal space received interstitial brachytherapy between Sep. 2005 and Aug. 2006 via parapharynx involvement transnasal approach under the guidance of sinus endoscopy. The 3-dimensional (3D) planning system was used to delineate target volume, optimize dose distribution, and perform interstitial brachytherapy after CT scan. The depths of catheters under mucosa on the moment of inserting and pulling out were measured. The efficacy and complications were assessed.All catheters were intubated into tumors successfully; the veracity of catheter location was 100%. The submucosa depths of catheters were (9.59+/-2.72) mm when inserted and (9.43+/-2.30) mm when pulled out, without significant difference (t = 0.23,P0.05); the shift length was (0.75+/-0.75) mm. The patients were followed up from 3 to 15 months (median, 6 months), and no one dropt out. Three cases of irradiation-associated turbinate adhesion occurred and were cured after lysis; no infection, serious bleeding, palatal perforation, nasopharyngeal necrosis, and other serious complications occurred. All tumors disappeared in 3 months after treatment. No local recurrence and distant metastasis occurred.The nasopharyngeal and parapharyngeal catheterization with sinus endoscopy guidance is accurate, steady, safe, and feasible. Interstitial brachytherapy is effective for tumor residue in the nasopharynx or parapharyngeal space of NPC patients after radiotherapy without serious complications.

Some patients with local persistent or recurrent nasopharyngeal carcinoma (NPC) could achieve long-term survival after re-irradiation, but the irradiation-related complications are severe. Salvage surgical operation has similar, even better, curative effect, with no irradiation injury, but conventional surgical approaches may lead to serious damage, and unclear view of operation field is the obstacle for en bloc excision of the tumor. This study was to explore a new salvage surgical operation via mini-invasive endoscopic transnasal approach for recurrent NPC.Endoscopic nasopharyngectomy via mini-invasive endoscopic transnasal approach was performed in 25 patients with local persistent or recurrent NPC after radiotherapy between Sep. 2004 and Jan. 2007 in Cancer Center of Sun Yat-sen University. Local control conditions and complications were assessed.All patients received successful radical resection via endoscopic transnasal approach; only 1 had positive surgical margin. No one received postoperative radiotherapy. During follow-up of 3-31 months (median, 13 months), 1 patient had local persistence, 3 had local recurrence, but none had distant metastasis or death. The 1-year overall survival rate was 100%; the 1-year recurrence-free survival rate was 86.0%. No trismus, dysphagia, dysphonia, other surgical complications, and perioperative death occurred.Salvage surgical operation via endoscopic transnasal approach can expose the whole nasopharynx and the shallow parapharynx for an oncologic resection of local persistent or recurrent NPC. The complications are few and mild; the short-term results are satisfactory.

The clinical classification of nasopharyngeal carcinoma (NPC) depends mainly on the materials of medical imaging. This study was to investigate the application of magnetic resonance imaging (MRI) to the clinical classification of NPC.One hundred patients with NPC confirmed by pathohistology received MRI and computed tomography (CT) within 15 days before treatment from May 2002 to Jun. 2005. The patients included 74 men and 26 women with a median age of 46 (21-60). The detection rates of involved sites by MRI and CT were calculated and compared using Chi(2) test. The clinical classification was performed according to 92'staging system of China. The constituent ratios of cases at different T, N, and clinical stages classified by MRI and CT were analyzed by Chi(2) test.The detection rates of skull base bone destruction and retropharyngeal lymph node involvement were significantly lower by CT than by MRI (31.0% vs. 56.0%, Chi(2)=12.715, P=0.000; 40.0% vs. 55.0%, Chi(2)=4.511, P=0.034). The constituent ratio of cases at T1-T4 stages classified by MRI was different from that classified by CT (Chi(2)=8.339, P=0.039), but there was no difference in N staging (Chi(2)=0.275, P =0.965) and clinical classification (Chi(2)=5.525, P=0.137).MRI is more sensitive than CT in detecting skull base bone destruction and retropharyngeal lymph node involvement of NPC. MRI may upstage T classification, tends to upstage clinical classification, and has no influence on N classification of NPC.

Nasopharyngeal carcinoma (NPC) patients with negative cervical lymph node (N0-NPC) account for 20% -30% of all NPC patients. Prophylactic irradiation to the upper neck is a criterion of treatment for these patients. But some authors suggest to prophylactically irradiate the the whole neck. This study was to analyze and compare long-term outcomes of the N0-NPC patients treated by prophylactic irradiation to the upper neck and to the whole neck, and explore radiotherapy on neck for N0-NPC patients.A total of 178 N0-NPC patients, proved by pathology, were treated in our hospital from Jul. 1998 to Dec. 1999. Of the 178 patients, 88 received prophylactic irradiation to the upper neck (upper neck group), 90 received prophylactic irradiation to the whole neck (whole neck group). Kaplan-Meier method and log-rank test were used to analyze and compare survival rate of the 2 groups. Cox model was used to study prognostic factors of N0-NPC.The 1-, 3-, and 5-year overall survival rates were 98.9%, 90.9%, and 80.7% in upper neck group, and 97.8%, 80.0%, and 71.1% in whole neck group (P = 0.224). The 1-, 3-, and 5-year disease-free survival rates were 93.2%, 80.7%, and 77.3% in upper neck group, and 85.6%, 68.9%, and 64.4% in whole neck group (P = 0.163). The incidence of cervical lymph nodes recurrence was 1.14% in upper neck group, and 1.09% in whole neck group (P0.05). Multivariate analysis showed that gender, T stage, and short-term outcome were independent prognostic factors of N0-NPC.Prophylactic irradiation to upper neck is recommended for N0-NPC patients.

Capecitabine is an oral fluoropyrimidine, which is converted to fluorouracil (5-FU) by exploiting the comparatively higher activity of thymidine phosphorylase (TP) in tumor tissue. This study was designed to measure the maximum tolerated dose (MTD) of capecitabine in the patients with nasopharyngeal carcinoma.Medical records of 36 patients with nasopharyngeal carcinoma treated with radiation and capecitabine were reviewed. The median dose of capecitabine was 1 600 mgx(m(2)xd)(-1) [700-2 500 mgx(m(2)xd)(-1)] orally for 2 weeks followed 1 week of rest and then another cycle. All the patients received a total dose ranging from 66 Gy to 74 Gy over 6-7.4 weeks.In the 2 300 mgx(m(2)xd)(-1) group, Grade III toxicities observed were hang-foot syndrome (1 patient) and diarrhea (1 patient).Concurrent administration of capecitabine and radiation were tolerable in the patients with nasopharyngeal carcinoma. The maximum tolerated dose is 2 300 mgx(m(2)xd)(-1), The recommended phase II dose is 1 700 mgx(m(2)xd)(-1) daily administered by this intermittent schedule.