Abeloff's Clinical Oncology Pdf 14 ((LINK))

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The only way to cure NPC is with definitive radiotherapy. A nasopharyngeal tumor warrants a discussion regarding the extent of irradiation and the prime consideration is the likelihood of relapse. Different treatment modalities should be considered with the primary aim being relief of symptoms as a result of tumor obstruction. Recurrent cancer remains a contraindication to further radiation. Curative-intent resection with or without adjuvant cisplatin for cervical lymph node metastases remains best avoided. Radiation therapy is combined with resection in selected patients with metastatic disease. Induction regimens for advanced-stage disease include platins, CHOP, and chemotherapy combinations such triplet, doublet, or single agent. Adjuvant radiotherapy remains the standard of care after surgical treatment. High-dose chemotherapy with autologous stem-cell transplantation should be reserved for selected patients with multiple extranodal sites of disease per se, or in consideration of the presence of bulky retroperitoneal nodal disease (large tumor burden). Patients with stage III disease should be considered for high dose chemotherapy in addition to conventional chemotherapy (regimens with an intent to cure) [45,46].

NPC has historically been treated with surgery and radiotherapy as definitive therapy. Unfortunately, experience with combined modality therapy remains rare because of the high tumor burden. The role of adjuvant or salvage chemotherapy has not been well defined. A few studies have attempted to stage and/or restage under the current World Health Organization system and the International Lymphoma Staging System. Conventional radiotherapy with a dose of 50-60 Gy over 25-28 fractions, delivered with or without boost to involved nodes, has been favored in the past. Most recently, intensity-modulated radiation therapy has been used, which allows for a treatment with a tighter dose distribution that could potentially decrease the volume of normal tissue within the target volume. Modified-fractionation protocols have been employed in recent years. Patients who received non-conventional therapies, such as chemotherapy have a median disease-free survival with radiotherapy alone of 18 months and with post-operative radiotherapy of 24 months. RTOG 91-11 compared postoperative RT with 50 Gy compared with no RT and showed an 8.2% and 7.8% RFS for the postoperative RT and no RT groups, respectively (P=0.06). d2c66b5586

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