Quality of Life Clinical Trial
Official title:
Multiple Centre, Randomised, Controlled Trial of Hyperfractionated IMRT and Conventional Fraction IMRT for Patients With Loco-regionally Recurrent Nasopharyngeal Carcinoma.
This study evaluates the hyperfractionated IMRT in the treatment of patients with locally recurrent nasopharyngeal carcinoma. Half of participants will receive hyperfractionated IMRT, while the other half will receive conventional fraction IMRT.
Local recurrence is one of the most challenging issues faced with nasopharyngeal carcinoma
(NPC) patients. 8.4% to 10.9% of the patients developed recurrent diseases at the primary
or/and regional site after definitive radiotherapy. Although some patients with limited
recurrent lesions underwent surgery, the main treatment for these recurrent NPC patients was
still re-irradiation.
Multiple retrospective and prospective studies have reported: under the condition of
conventional fraction IMRT with the total dose of 60 gray (Gy) (division 27 times, once a
day, every 2.2Gy), you can get a better local tumor control rate and survival outcome.
However, the patients still underwent some severe late complications including nasopharyngeal
necrosis, nasopharyngeal bleeding, temporal lobe necrosis, with the incidence rates of 28.8%,
18.6%, 20.3%, respectively. Approximately 50% of recurrent NPC patients died of these severe
late complications, significantly compromising the overall survival rate of the patients.
Previous studies showed that hyperfractionated radiotherapy could reduce severe late
complication rates significantly, without affecting the local control rate. Indeed, we found
that under the condition of equal irradiation time and tumor equivalent dosage between
hyperfractionated IMRT (total dose of 65Gy, division 54 times, twice a day, once 1.2Gy,
irradiation interval of 6-8 hours) and conventional fraction IMRT (total dose of 60Gy,
division 27 times, once a day, every 2.2Gy), the normal late responding tissues equivalent
dosage( EQD2) significantly decreased compared with conventional fraction IMRT. Therefore,
the use of hyperfractionated IMRT is expected to decrease severe late complications rates,
thereby improving the quality of life and overall survival of patients.
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