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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 (FuDR750 mg/m2, 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.

Background and Objective: Currently, the serum immunoglobulin A against Epstein-Barr virus capsid antigen (EBV-VCA/IgA) is one of the most commonly used markers for diagnosis of nasopharyngeal carcinoma (NPC). However, its value for prognostic implication in NPC patients is unclear. This study was to evaluate the relationship between pretreatment titers of EBV-VCA/IgA and NPC patients' survival., Methods: The clinicopathologic data of 317 NPC patients treated in Sun Yat-sen University Cancer Center between 1990 and 2003 were retrieved from the registration system of cancer incidence and mortality of Sihui city, Guangdong province. The correlation of pretreatment EBV-VCA/IgA titers to the survival of these patients was analyzed., Results: Pretreatment VCA/IgA titer was significantly higher in stage III-IV NPC patients than in stage I-II patients (p = 0.01). The survival time was significantly shorter in the 170 patients with higher EBV-VCA/IgA titers (>or= 1:160) than in the 147 patients with lower EBV-VCA/IgA titers ( < 1:160). The 5-year survival rate was 65% in low EBV-VCA/IgA titer group and 43% in high titer group (p = 0.01). Multivariate analyses showed that clinical stage, sex, the year of treatment, and pretreatment serum EBV-VCA/IgA titer were all independent prognostic factors of NPC., Conclusion: Pretreatment serum EBV-VCA/IgA titer may be used as an independent prognostic marker of NPC.

Background & Objective: Management of locally recurrent nasopharyngeal carcinoma (NPC) is difficult. External beam re-irradiation could cure some patients but might cause severe radiation injury. This study was to evaluate the clinical value of endoscopic microwave coagulation therapy as salvage treatment for locally recurrent NPC., Methods: Between Aug. 1994 and Apr. 2005, 55 patients with locally recurrent NPC (stage rT1) were treated with endoscopic microwave coagulation therapy. Local progression-free and overall survival were observed., Results: The median follow-up was 102.1 months (range, 22.4-153.9 months). The median time from last irradiation to recurrence was 22.1 months (range, 6.5-125.6 months). Five patients had local failure. The 5-year local progression-free and overall survival rates were 90.7% and 93.6%, respectively. No patient had intraoperative complications. One patient had nasopharyngeal necrosis after operation, and was healed after one month., Conclusions: Endoscopic microwave coagulation therapy is effective without severe complications in locally recurrent NPC patients. It is a minimally invasive therapy for recurrent NPC.

Background & Objective: Oral mucositis caused by radiotherapy is the most familiar complication of nasopharyngeal carcinoma (NPC), and it has strong impact on the patients. This study was to screen high risk factors of oral mucositis, and establish a mathematical model for forecasting its incidence probability in NPC patients., Methods: Clinical and experimental factors of 102 NPC patients with oral mucositis were analyzed by univariate analysis, multifactorial Logistic regression, and discriminant analysis., Results: Multifactorial Logistic regression showed that chemotherapy, bad oral hygiene status, not using antibiotic at early stage mucositis, smoking history were high risk factors of serious mucositis. A discriminant function was set up using these 4 factors, with positive forecast value of 75.9%, negative forecast value of 79.5%, sensitivity of 83.0%, and specificity of 71.4%., Conclusions: Chemotherapy, bad oral hygiene status, not using antibiotic at early stage mucositis, smoking history are high risk factors of serious mucositis after radiotherapy for NPC; early treatment has some preventive effect on it. The discriminant function may help to predict the incidence of serious oral mucositis.

Background & Objective: Oxygen increases tumor sensitivity to radiotherapy; tumor hypoxia is more prevalent in tumor patients with pretreatment hemoglobin concentration of < 130 g/L. This study was to evaluate impact of pre-radiotherapy hemoglobin level on radiotherapy outcome of nasopharyngeal carcinoma (NPC) patients., Methods: Clinical and follow-up data of 166 NPC patients received definitive radiotherapy from 1999 to 2000 were reviewed. Pre-radiotherapy hemoglobin levels were stratified as high (> or =130 g/L) and low (< 130 g/L). Cox regression analysis was used to determine factors affecting local control., Results: The median pre-radiotherapy hemoglobin level of the 166 patients was 135 (85-189) g/L. Hemoglobin was < 130 g/L in 68 (41%) patients, and > or =130 g/L in 98 (59%) patients. The pre-radiotherapy hemoglobin level of < 130 g/L was related to low 3-year local relapse-free survival rate (78% vs. 90%, P=0.015), but had no relations with distant metastasis-free survival (75% vs.77%, P=0.763) and overall survival rates (73% vs. 83%, P=0.056). Multivariate analysis showed that pre-radiotherapy hemoglobin level, T stage, and gender were independent prognostic factors for local failure., Conclusions: Pre-radiotherapy hemoglobin of < 130 g/L is a prognostic factor for local control of NPC. Strategies for maintaining pre-radiotherapy hemoglobin of > or =130 g/L before radiotherapy and during treatment should be further explored.

Objective: To investigate the diagnosis and management on osteoradionecrosis (ORN) of skull base in the patients with nasopharyngeal carcinoma (NPC) after radiotherapy., Methods: All patients (n = 15) diagnosed as NPC and ORN of skull base were studied on the clinical data, diagnosis and therapy., Results: All the patients were found with foul odor, headache, bleeding and exposed necrotic bone. 9 patients were treated by surgery, among them 2 patients died of temporal lobe radionecrosis, and the survival time of remaining 7 patients was 2 to 7 years. 5 patients with extensive ORN and 1 patient with local ORN were treated by conservative methods, among them 3 died of nasopharyngeal bleeding and 1 died of respiratory and heart failure, survival time of the remaining 2 patients was 3 to 5 years., Conclusions: ORN can be diagnosed by clinical characteristics, CT or MR, and endoscopic findings. Surgery is the best choice for ORN. The patients with extensive ORN or radiation-induced cranial neuropathy had poor prognosis. The most common causes of death were nasopharyngeal bleeding and exhaustion.

Background & Objective: 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., Methods: 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., Results: In the 2 300 mgx(m(2)xd)(-1) group, Grade III toxicities observed were hang-foot syndrome (1 patient) and diarrhea (1 patient)., Conclusion: 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.