FEASIBILITY AND FEASIBILITY AND EFFICIENCY OF EFFICIENCY OF

CONCURRENT CHEMO-CONCURRENT CHEMO-RADIOTHERAPY FOR RADIOTHERAPY FOR NASOPHARYNGEAL NASOPHARYNGEAL

CARCINOMA PATIENTS CARCINOMA PATIENTS

Pembimbing : dr.Khairan Irmansyah, SpTHT-KL. MKes

Dipresentasikan oleh : Lailatul Faradila – FK UPN

Alethea Andantika – FK UKRIDA

Citation: Essaidi I, Nasr C, Kochbati L, Maalej M. Feasibility and efficiency of concurrent chemo-radiotherapy for

nasopharyngeal carcinoma patients. J Nasopharyng Carcinoma, 2015, 1(21): e21. doi:10.15383/jnpc.21.

Competing interests: The authors have declared that no competing interests exist.

Conflict of interest: None.

Copyright:2014 By the Editorial Department of Journal of Nasopharyngeal Carcinoma. This is an open-access article

distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,

distribution, and reproduction in any medium, provided the original author and source are credited.

OVERVIEW :OVERVIEW :NASOPHARYNGEAL NASOPHARYNGEAL

CARCINOMACARCINOMA

EPIDEMIOLOGYEPIDEMIOLOGY This neoplasm has a notable ethnic and

geographic distribution with a high prevalence in Southeast Asian and North African

EPIDEMIOLOGYEPIDEMIOLOGY

ETIOLOGYETIOLOGY

SYMPTOMSSYMPTOMS

CLINICAL MANIFESTATI CLINICAL MANIFESTATIONON Neck lump Neck lump 60%60% Ear (s) plugging & fullness Ear (s) plugging & fullness 41%41% Hearing loss Hearing loss 37%37% Nasal bleeding Nasal bleeding 30% 30% Nasal obstruction Nasal obstruction 29%29% Head pain Head pain 16% 16% Ear pain Ear pain 14%14% Neck pain Neck pain 13%13% Weight loss Weight loss 10%10% Diplopia Diplopia 8%8%

DIAGNOSING NASOPHARYNGEAL CANCER

CLASSIFICATIONCLASSIFICATION WHO Type I (Keratinizing squamous cell carcinoma) WHO Type II (Nonkeratinizing squamous cell

carcinoma) WHO Type III (Undifferentiated or poorly differentiated)

T1

The tumor is just within the nasopharynx, or it has grown into the oropharynx and/or nasal cavity, but there is no extension into the parapharyngeal space (soft tissue space behind and to the side of the pharynx).

T2The tumor extends into the parapharyngeal space (soft tissue space next to the pharynx).

T3The tumor has grown into the bone of the head, including the skull base and/or the sinuses.

T4

The tumor has grown into the skull and/or involves the cranial nerves, hypopharynx, or eye socket (orbit). Or it has extended to the infratemporal fossa or masticator space.

N0There is no evidence of cancerous spread to lymph nodes in the neck or retropharyngeal space.

N1

There are cancerous lymph nodes on just one side of the neck, where the largest is 6 centimeters or less, and all the lymph nodes are above the supraclavicular fossa. Also, the cancer is at this stage if the lymph nodes are found in the retropharyngeal space (6 centimeters or less in size, one side or both).

N2

There are lymph nodes with cancer on both sides of the neck (where the biggest lymph node is 6 centimeters or less in size, and all the lymph nodes are above the supraclavicular fossa).

N3aThere is a lymph node with cancer that is bigger than 6 centimeters.

N3bThere is a cancerous lymph node of any size that is far down in the neck, just above the clavicles (supraclavicular fossa).

M0No evidence of distant (outside the head and neck) spread.

M1There is evidence of spread outside of the head and neck (i.e., in the lungs, bone, brain, etc.).

Stage 0 Tis N0 M0

Stage 1 T1 N0 M0

Stage 2 T1 N1 M0

T2 N0 M0

T2 N1 M0

Stage 3 T1 N2 M0

T2 N2 M0

T3 N0 M0

T3 N1 M0

T3 N2 M0

Stage 4a T4 N0 M0

T4 N1 M0

T4 N2 M0

Stage 4b Any T N3 M0

Stage 4c Any T Any N M1

Factors That Can Affect the Chances of Being Cured

StageThis is the most important factor that affects the chances of being cured. Cancers in earlier stages usually have better outcomes.

Type and GradeThe type and grade of tumor show how aggressive a tumor is.

Spread to Lymph NodesIf there is spread to lymph nodes in the neck, there is a lower chance of a cure.

The Tumor Margins (edges)Some say the ability to completely remove the tumor is the single most important factor in whether a person will be cured.

Spread into Nearby Body Parts

Spread into large nerves, skin and bone has been shown to indicate a worse prognosis.

JOURNALJOURNAL

PATIENT AND METHODS

Characteristics No. of patients Percentage (%)

Age  Median Sex Male Female

41 years 25 8

Range (11-66 years) 76 24

Pathology WHO type III

33 100

T stage (TNM 2002) T0 T1 T2 T3 T4

1 2 8 15 7

3 6 24 46 21

N stage (TNM 2002) N0 N1 N2 N3

6 12 11 4

18 36 34 12

2. PATIENT EVALUATION AND FOLLOW UP

3. STATISTICAL METHOD

Study endpoints include: Acute toxicities Overall survival (OS) Disease-free survival (DFS) Loco-regional relapse-free survival (LRRFS) Metastasis relapse-free survival (MRFS).

RESULTS

DISCUSSION

NPC highly radiosensitive and chemosensitive

we conclude that CCRT with or without ACT is also applicable to patients in endemic areas and should be standard of practice in locally advanced disease

At present, concurrent CT during the course of RT should be considered the standard of care. Weekly (30-40 mg/m2) as well as 3-weekly (100 mg/m2) cisplatin-based regimens are accepted as standard practice.

CONCLUSION

Our 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.

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