Late Course Accelerated Hyperfractionated Radiotherapy Combined withChemotherapy for Stage III and IVa Nasopharyngeal Carcinoma

Objective: To evaluated the treatment results of late course accelerated hyperfractionated radiotherapy combined with chemotherapy for Stage Ⅲ and Ⅳa nasopharyngeal carcinoma. Methods: One hundred patients with Stage Ⅲ and Ⅳa nasopharyngeal carcinoma were randomized into two groups. The late course accelerated hyperfractionated radiotherapy combined with chemotherapy group received the induction chemotherapy for two cycles, followed by conventional fractionation radiotherapy to a dose 40 gray, than changed into accelerated hyperfractionated radiotherapy to a total dose of 70 gray, and used another two cycles of adjuvant chemotherapy. The conventional fractionation radiotherapy combined with chemotherapy group received the chemotherapy that it similar to the late course accelerated hyperfractionated radiotherapy combined with chemotherapy group, and used the conventional fractionation radiotherapy to a total dose of 70 gray. Results: The 2 year overall survival rate were 83.6% in late coursed with accelerated hyperfractionated radiotherapy combine chemotherapy group and 79.7% in conventional fractionation radiotherapy combined with chemotherapy group, had no significant difference (P 0.05). The 2 year disease free survival rate were 76.5% in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group and 59.1% in conventional fractionation radiotherapy combined with chemotherapy group (P 0.05). The 2 year local regional free recurrence rate were 90.0% in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group and 69.7% in conventional fractionation radiotherapy group (P 0.05). There were the cranial nerves complications in two patients of the late course accelerated hyperfractionated radiotherapy combined with chemotherapy group. Conclusions: The results from this study show that the 2 year disease free survival rate and the 2 year local regional free recurrence rate in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group was significant better than in conventional fractionation radiotherapy group, but the radiation induced damage to the cranial nerves was improved in late course accelerated hyperfractionated radiotherapy combined with chemotherapy group, the long term survival rate and the late complication need follow up further.