FEASIBILITY AND

EFFICIENCY OF
CONCURRENT CHEMO-
RADIOTHERAPY FOR
NASOPHARYNGEAL
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 :
NASOPHARYNGEAL
CARCINOMA
EPIDEMIOLOGY
 This neoplasm has a notable ethnic and
geographic distribution with a high prevalence in
Southeast Asian and North African
EPIDEMIOLOGY
ETIOLOGY
SYMPTOMS
CLINICAL
MANIFESTATION
 Neck lump 60%
 Ear (s) plugging & fullness 41%
 Hearing loss 37%
 Nasal bleeding 30%
 Nasal obstruction 29%
 Head pain 16%
 Ear pain 14%
 Neck pain 13%
 Weight loss 10%
 Diplopia 8%
DIAGNOSING NASOPHARYNGEAL
CANCER
CLASSIFICATION
 WHO Type I (Keratinizing squamous cell carcinoma)
 WHO Type II (Nonkeratinizing squamous cell carcinoma)
 WHO Type III (Undifferentiated or poorly differentiated)
 The tumor is just within the nasopharynx, or it has
grown into the oropharynx and/or nasal cavity, but
T1 there is no extension into the parapharyngeal space
(soft tissue space behind and to the side of the
pharynx).

The tumor extends into the parapharyngeal space (soft

T2
tissue space next to the pharynx).

The tumor has grown into the bone of the head,

T3
including the skull base and/or the sinuses.
The tumor has grown into the skull and/or involves the
cranial nerves, hypopharynx, or eye socket (orbit). Or it
T4
has extended to the infratemporal fossa or masticator
space.
 There is no evidence of cancerous spread to lymph nodes
N0
in the neck or retropharyngeal space.
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.
N1
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).
There are lymph nodes with cancer on both sides of the
neck (where the biggest lymph node is 6 centimeters or
N2
less in size, and all the lymph nodes are above the
supraclavicular fossa).
There is a lymph node with cancer that is bigger than 6
N3a
centimeters.
There is a cancerous lymph node of any size that is far
N3b down in the neck, just above the clavicles
(supraclavicular fossa).
 No evidence of distant (outside the head
M0
and neck) spread.
There is evidence of spread outside of the
M1 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
This is the most important factor that affects the
Stage chances of being cured. Cancers in earlier stages
usually have better outcomes.

The type and grade of tumor show how aggressive

Type and Grade
a tumor is.

If there is spread to lymph nodes in the neck,

Spread to Lymph Nodes
there is a lower chance of a cure.

Some say the ability to completely remove the

The Tumor Margins (edges) tumor is the single most important factor in
whether a person will be cured.

Spread into large nerves, skin and bone has been

Spread into Nearby Body Parts
shown to indicate a worse prognosis.
JOURNAL
PATIENT AND METHODS
Characteristics No. of patients Percentage (%)

Age  
Median 41 years Range (11-66
Sex 25 years)
Male 8 76
Female 24
Pathology 33 100
WHO type III
T stage (TNM 2002)
T0 1 3
T1 2 6
T2 8 24
T3 15 46
T4 7 21
N stage (TNM 2002)
N0 6 18
N1 12 36
N2 11 34
N3 4 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.
THANK YOU