Initial treatment results of induction chemotherapy followed by concurrent chemoradiotherapy with IMRT/VMAT technique in stage N3 nasopharyngeal carcinoma at National Cancer Hosptial
Main Article Content
Abstract
This retrospective descriptive study included 114 patients diagnosed at stage N3 nasopharyngeal cancer (NPC) (stage IVA, AJCC 8th edition) and treated at National Cancer Hospital from 2019 to 2024. The regimen was induction chemotherapy (IC) followed by concurrent high-tech chemoradiotherapy (IMRT/VMAT). The study aimed to describe clinical and subclinical features and assess initial outcomes. Median age was 46.4 years old; the male-to-female ratio was 2.08. Cervical lymph nodes located below lower border of the cricoid cartilage were more commonly found than > 6 cm lymph nodes. Extranodal extension were associated with a complete initial response. The overall response rate (ORR) after IC was 97.3%, and 94.7% after treatment ended, with a 71.9% complete response. Combining IC with high-tech concurrent therapy IMRT/VMAT led to positive initial disease control and good tolerability.
Article Details
Keywords
nasopharyngeal cancer, N3 lymph node metastases, induction chemotherapy, IMRT/VMAT
References
2. Jiromaru R, Nakagawa T, Yasumatsu R. Advanced Nasopharyngeal Carcinoma: Current and Emerging Treatment Options. Cancer Manag Res. 2022;14:2681-2689. doi:10.2147/cmar.S341472
3. Lee AWM, Ngan RKC, Ng WT, et al. NPC-0501 trial on the value of changing chemoradiotherapy sequence, replacing 5-fluorouracil with capecitabine, and altering fractionation for patients with advanced nasopharyngeal carcinoma. Cancer. Aug 15 2020;126(16):3674-3688. doi:10.1002/cncr.32972
4. Sun Y, Li WF, Chen NY, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. Nov 2016;17(11):1509-1520. doi:10.1016/s1470-2045(16)30410-7
5. Zhang Y, Chen L, Hu G-Q, et al. Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma. New England Journal of Medicine. 2019;381(12):1124-1135. doi:10.1056/nejmoa1905287
6. Wu LR, Liu YT, Jiang N, et al. Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: An analysis of 614 patients from a single center. Oral Oncol. Jun 2017;69:26-32. doi:10.1016/j.oraloncology.201 7.03.015
7. Chen J, Liu T, Sun Q, Hu F. Clinical and prognostic analyses of 110 patients with N3 nasopharyngeal carcinoma. Medicine (Baltimore). Dec 2018;97(49):e13483. doi:10.1097/md. 0000000000013483
8. Nguyễn Văn Đăng, Đỗ Huyền Chi. Kết quả hóa chất dẫn đầu Gemcitabine - Cisplatin theo sau bởi hóa xạ trị ung thư vòm mũi họng giai đoạn III-IVA tại Bệnh viện K. Tạp chí Nghiên cứu Y học. 11/11 2024;183(10):270-279. doi:10.52852/tcncyh.v183i10.2644
9. Nguyễn Văn Đăng, Nguyễn Thị Thu Nhung. Kết quả hóa chất dẫn đầu phác đồ TCF theo sau bởi hóa xạ trị ung thư vòm mũi họng giai đoạn III - IVA tại Bệnh viện K. Tạp chí Nghiên cứu Y học. 11/11 2024;183(10):280-290. doi:10.52852/tcncyh.v183i10.2701
10. Nguyễn Minh Tuấn, Hoàng Đào Chinh, Tô Quang Duy, Nghiêm Thị Minh Châu, Nguyễn Văn Ba, Bùi Quang Biểu. Kết quả hóa xạ trị đồng thời sau hóa chất dẫn đầu điều trị ung thư vòm mũi họng giai đoạn III-IVa. Tạp chí Y Dược lâm sàng 108. 2025;doi:10.52389/ ydls.v20i4.2701
11. Lâm Đông Phong, Hoàng Đức Kiệt, Trần Thanh Phương. Đặc điểm phân bố hạch di căn sau họng và các vùng cổ khác trong ung thư vòm họng trên chụp cộng hưởng từ. Tạp chí Nghiên cứu Y học. 02/22 2022;150(2):174-181. doi:10.52852/tcncyh.v150i2.730
12. Bossi P, Chan AT, Licitra L, et al. Nasopharyngeal carcinoma: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up(†). Ann Oncol. Apr 2021;32(4):452-465. doi:10.1016/j.annonc.2020.12.007
13. Bese NS, Hendry J, Jeremic B. Effects of Prolongation of Overall Treatment Time Due To Unplanned Interruptions During Radiotherapy of Different Tumor Sites and Practical Methods for Compensation. International Journal of Radiation Oncology, Biology, Physics. 2007;68(3):654-661. doi:10.1016/j.ijrobp.2007.03.010
14. Teoh M, Clark CH, Wood K, Whitaker S, Nisbet A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. Nov 2011;84(1007):967-96. doi:10.1259/bjr/22373346