Simultaneous Modulated Accelerated Radiation Therapy and Concurrent Weekly Paclitaxel in the Treatment of Locally Advanced Nasopharyngeal Carcinoma

Objectives: To evaluate the feasibility and efficacy of simultaneous accelerated radiation therapy (SMART) andconcurrent weekly paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma.
Methods: Fortyonepatients with pathologically confirmed nasopharyngeal carcinoma were treated by SMART with concurrentweekly paclitaxel. Daily fraction doses of 2.5 Gy and 2.0 Gy were prescribed to the gross tumor volume (GTV)and clinical target volume (CTV) to a total dose of 70 Gy and 56 Gy, respectively. Paclitaxel of 45 mg/m2 wasadministered concurrently with radiation therapy every week. Adjuvant chemotherapy was given four weeksafter the completion of the radiotherapy (RT) if the tumor demonstrated only a partial response (PR).
Results:All patients completed the radiotherapy (RT) course. Adjuvant chemotherapy was administered to 12 patientsdue to PR. The CR (complete remission) rate was 82.9% three months after RT. Thirty-nine (95.1%) patientscompleted the concurrent weekly chemotherapy with paclitaxel, and two patients skipped their sixth course.Seven patients had a 15% dosage reduction at the fifth and sixth course due to grade 3 mucositis. The medianfollow-up was 30 (range, 14-42) months. The three-year overall survival (OS), metastases-free survival (MFS),and local control rates were 77.0%, 64.4%, and 97.6%, respectively. No correlation between survival rate and Tor N stage was observed. Grade 3 acute mucositis and xerostomia were present in 17.1% and 7.1%, respectively.
Conclusion: SMART with concurrent weekly paclitaxel is a potentially effective and toxicity tolerable approachin the treatment of locally advanced NPC.