Journal reading "Feasibility and efficiency of concurrent chemo-radiotherapy for nasopharyngeal carcinoma patients" disusun oleh : Lailatul Faradila (FK UPN Jakarta) dan Alethea Andantika (FK UKRIDA) Pembimbing : dr. Khairan Irmansyah, Sp.THT-KL, MKes KEPANITERAAN KLINIK DEPARTEMEN ILMU KESEHATAN THT RSPAD GATOT SUBROTO PERIODE 25 MEI 2015 – 26 JUNI 2015

1. FEASIBILITY ANDFEASIBILITY AND
EFFICIENCY OFEFFICIENCY OF
CONCURRENT CHEMO-CONCURRENT CHEMO-
RADIOTHERAPY FORRADIOTHERAPY FOR
NASOPHARYNGEALNASOPHARYNGEAL
CARCINOMA PATIENTSCARCINOMA PATIENTS
Pembimbing : dr.Khairan Irmansyah, SpTHT-KL. MKes
Dipresentasikan oleh :
Lailatul Faradila – FK UPN
Alethea Andantika – FK UKRIDA

2. 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.

3. OVERVIEW :OVERVIEW :
NASOPHARYNGEALNASOPHARYNGEAL
CARCINOMACARCINOMA

4. EPIDEMIOLOGYEPIDEMIOLOGY
 This neoplasm has a notable ethnic and
geographic distribution with a high prevalence in
Southeast Asian and North African

5. EPIDEMIOLOGYEPIDEMIOLOGY

6. ETIOLOGYETIOLOGY

7. SYMPTOMSSYMPTOMS

8. CLINICALCLINICAL
MANIFESTATIONMANIFESTATION
 Neck lumpNeck lump 60%60%
 Ear (s) plugging & fullnessEar (s) plugging & fullness 41%41%
 Hearing lossHearing loss 37%37%
 Nasal bleedingNasal bleeding 30%30%
 Nasal obstructionNasal obstruction 29%29%
 Head painHead pain 16%16%
 Ear painEar pain 14%14%
 Neck painNeck pain 13%13%
 Weight lossWeight loss 10%10%
 DiplopiaDiplopia 8%8%

9. DIAGNOSING NASOPHARYNGEAL
CANCER

11. CLASSIFICATIONCLASSIFICATION
 WHO Type I (Keratinizing squamous cell carcinoma)
 WHO Type II (Nonkeratinizing squamous cell carcinoma)
 WHO Type III (Undifferentiated or poorly differentiated)

12. T1
The tumor is just within the nasopharynx, or it has
grown into the oropharynx and/or nasal cavity, but
there is no extension into the parapharyngeal space
(soft tissue space behind and to the side of the
pharynx).
T2
The tumor extends into the parapharyngeal space (soft
tissue space next to the pharynx).
T3
The tumor has grown into the bone of the head,
including the skull base and/or the sinuses.
T4
The tumor has grown into the skull and/or involves the
cranial nerves, hypopharynx, or eye socket (orbit). Or it
has extended to the infratemporal fossa or masticator
space.

13. N0
There is no evidence of cancerous spread to lymph nodes
in the neck or retropharyngeal space.
N1
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.
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).
N2
There are lymph nodes with cancer on both sides of the
neck (where the biggest lymph node is 6 centimeters or
less in size, and all the lymph nodes are above the
supraclavicular fossa).
N3a
There is a lymph node with cancer that is bigger than 6
centimeters.
N3b
There is a cancerous lymph node of any size that is far
down in the neck, just above the clavicles
(supraclavicular fossa).

14. M0
No evidence of distant (outside the head
and neck) spread.
M1
There is evidence of spread outside of the
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

16. Factors That Can Affect the Chances of
Being Cured
Stage
This is the most important factor that affects the
chances of being cured. Cancers in earlier stages
usually have better outcomes.
Type and Grade
The type and grade of tumor show how aggressive
a tumor is.
Spread to Lymph Nodes
If there is spread to lymph nodes in the neck,
there is a lower chance of a cure.
The Tumor Margins (edges)
Some say the ability to completely remove the
tumor is the single most important factor in
whether a person will be cured.
Spread into Nearby Body Parts
Spread into large nerves, skin and bone has been
shown to indicate a worse prognosis.

17. JOURNALJOURNAL

18. PATIENT AND METHODS

19. Characteristics No. of patients Percentage (%)
Age
Median
Sex
Male
Female
41 years
25
8
Range (11-66
years)
76
24
Pathology
WHO type III
33 100
T stage (TNM 2002)
T0
T1
T2
T3
T4
1
2
8
15
7
3
6
24
46
21
N stage (TNM 2002)
N0
N1
N2
N3
6
12
11
4
18
36
34
12

20. 2. PATIENT EVALUATION AND
FOLLOW UP

21. 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).

22. RESULTS

27. 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.

28. 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.

29. THANK YOU