Palliative chemotherapy is the standard of care for patients with advanced nasopharyngeal carcinoma. Radiotherapy may be offered for patients who responded to chemotherapy for local control. However, the dose and fractionation schedules used varies between oncologists.
An online survey via email was conducted for all practicing oncologists in public hospitals in Malaysia. The questionnaires were sent to 42 oncologists. The questionnaires gathered data on their practice in giving radiotherapy to patients with advanced nasopharyngeal carcinoma who responded to palliative chemotherapy,.
33 oncologists responded to the questionnaire, which gave a response rate of 78.5%. Most oncologists (85%) will give radiotherapy if patients responded to palliative chemotherapy, and 90.9% will give radiotherapy alone without concurrent chemotherapy. The radiotherapy dose fractionation schedules vary among the oncologists, with 55Gy/20 fractions/4 weeks the commonest fractionation used (30.3%), followed by 40Gy/15 fractions/3 weeks (24.2%), and 9.1% choosing schedules such 30Gy/10 fractions/2 weeks, 45Gy/15 fractions/3 weeks, and 70Gy/35 fractions/7 weeks. The other fractionations used are 52Gy/13 fractions/2.5 weeks, 50Gy/25 fractions/5 weeks, 60Gy/25 fractions/5 weeks, 66Gy/33 fractions/6.5 weeks, and 60Gy/30 fractions/6 weeks. Most oncologists will prefer a fractionation schedules of 3-4 weeks duration (75.8%), with high enough dose to give a good local control and avoiding long treatment duration, as the radiotherapy is non-curative in nature.
There are currently no guidelines or consensus on the optimum radiotherapy dose fractionation schedules for this group of patients. The decision for the preferred dose-fractionation schedules have to take into consideration factors such as symptoms, disease extent and comorbidity. An optimum dose-fractionation schedule which does not prolong the treatment duration and giving the best local control is very much needed, especially in situations such as the current COVID-19 pandemic.
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