DIAGNOSTIC, THERAPEUTIC AND EVOLUTIONARY CHARACTERISTICS OF NASOPHARYNGEAL CANCER MANAGED WITH VMAT IN DEPARTMENT OF RADIOTHERAPY, MOHAMED V MILITARY TEACHING HOSPITAL - RABAT IN MOROCCO

Purpose: The aim of this study was to report the experience of Military Teaching Hospital Mohamed V (MTHM V) in the management of NPC treated with volumetric modulated arc therapy (VMAT) Materials and Methods: This is a retrospective study conducted between January 2013 and December 2017. All patients with a nasopharyngeal cancer were included. Patients who had distant metastasis at the time of diagnosis were excluded. The volumetric arc therapy modulation of intensity (VMAT) is the technique radiotherapy used in all our patients. Results: one hundred and one (101) patients with nasopharyngeal cancer were treated in our department. The average age was 42.95?16.36. The predominant histological type is undifferentiated carcinoma (UCNT) in 93 % of cases. Tumors were classified according to the American Joint Committee on Cancer (AJCC) classification of 2010 in Stage I : 1%, Stage II in 10.9%, Stage III in 45.5%, Stage IVa in 32.7% and stage IVb in 9.9%. The treatment consisted of neoadjuvant chemotherapy followedby concomitant radio chemotherapy (RCC) at 79.2 % of patients, an RCC immediately in 12.8 % of cases and 8 % of patients received neoadjuvant chemotherapy followed by exclusive radiotherapy. The therapeutic tolerance was good with 16.8% of acute radiomucite Grade 3, 8.9% of acute dermatitis Grade 3 and no complication Grade 4. The overall survival was 98.8% and 84.8% at 2 and 5 years respectively, and the PFS was 85.6% and 76.8% at 2 and 5 years, respectively. N3 and time to relapse were significant in multivariate analysis for OS. Neoadjuvant chemotherapy and N3 were significant in multivariate analysis for PFS. Conclusion: volumetric modulated arc therapy with concurrent chemoradiotherapy with additional neoadjuvant chemotherapy has good response and outcomes. Our findings are in good accordance with other series but further large studies are warranted to improve prognostic of this potentially curable malignancy.