Objective: The aim of this study are to evaluate the clinical effect and toxicities of cocurrent nedaplatin chemoradiotherapy with intensity modulated radiotherapy (IMRT)plus adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma. Method: A total of 60 patients with locally advanced nasopharyngeal carcinoma(according to Fuzhou 92 staging system)were enrolled into this study

40 patients had stage Ⅲ lesion while 20 patients had stage Ⅳa lesion.The regions of nasopharynx and upper and lower neck were all irradiated by IMRT technique. The prescribed dose 69.96 Gy was delivered to the gross tumor volume (PTV) and positive neck nodes (PTVnd); 59.36 Gy to the clinical target volume (PTV1)

covering the upper neck and area around the nasopharynx; and 50.96 Gy to the low neck and supraclavicular area (PTV2). The dose to 50% of the parotid was ≤35 Gy. The maximum dose to the lens

pituitary gland

temporo-mandibular joint

mandible

and temporal lobe was 9

54

60

70

60 Gy. The maximum dose to the brain stem

spinal cord

optic nerve and optic chiasma (PRV) was 54

40

54

54 Gy

respectively.Acute toxicities were evaluated according to EORTC/RTOG radiation morbidity scoring criteria.All patients received concurre chemoradiotherapy before three cycles of adjuvant chemotherapy. Result: With a median follow-up of 56 months

the 1

2

3

4-year locoregional control rate was 100% and 98.33%

93.3%

90.0%

the 1

2

3

4-year overall survival and distant metastasis free survival were 98.33%

98.33%

90.00%

85.0%and 96.67%

93.33%

86.7%

80.0%respectively. Conclusion: Cocurrent chemoradiotherapy with IMRT plus adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma is feasible

grade 3 to 4 mucositis and grade 3 to 4 hematologic toxicity are considered to be limiting factors of chemoradiotherapy and influence the quality of life.It may be able to improve the locoregional control rate and overall survival for locally advanced nasopharyngeal carcinoma and be worthy of further clinical investigation.