However, CHT was applied according to protocol using neoadjuvant CHT and weekly concomitant CHT. For illustrative purposes, the Vienna protocol was also studied in conjunction with the outcome data of the Rotterdam/Amsterdam series. Summating all cases treated with a boost (C + [C + B] = Ctotal), and comparing them with all patients without an EBT boost, now reveals a significant difference in the LRR (Table 2)

for advanced stage. This, however, was only the case for the T1,2N+ tumors: EBT boost 0% (0/34; Group B) vs. no EBT boost 14% (14/102; Group (C + [C − B]) (p = 0.023). For T3,4 tumors, most likely because of inadequate SNS-032 cell line tumor coverage by virtue of the RNA design, EBT does not significantly decreases the LRR: The difference of 11% (4/38; Group B) vs. 15% (17/111; Group C + (C − B)) Adriamycin cell line vs. was found to be nonsignificant (p = 0.463). The regional relapse rate for small tumors was 0%, for advanced tumors depending on

the tumor stage varied from 7% to 16%. An article by Kwong et al. (18) reports the LR to be an independent prognostic indicator for the development of M+. M+ was also shown to correlate with the N+ status of the neck. In a recent issue (2009) of the Chinese Journal of Cancer, an article by Han et al. (19) showed by multivariate analysis that T-classification had no predictive value for local control and survival, whereas N-classification was a significant prognostic factor

for overall (p < 0.001), metastasis-free (p < 0.001), and disease-free survival (p = 0.003). In summary, in their series of 305 NPC patients, N-classification was the main factor for prognosis. Moreover, a higher number of patients with M+ was observed with higher N-stage, that is, N0, N1, N2, and N3 disease corresponded with 0%, 19%, 30%, and 36%, respectively, of patients having M+ disease. In the present study, for the T1,2N+ patients, less LRs were found for those patients treated with an EBT boost (p = 0.023); this corroborates with literature findings (20). In fact, with regard to T3,4N0,+ NPC, the reduction DCLK1 of the LRR was found to be nonsignificant (p = 0.463). These observations are in line with what is to be expected of EBT using the RNA: Albeit a very useful tool, it was originally designed for small primary lesions (T1,2) only. Moreover, some factors might be of additional advantage in future treatment of advanced NPC cases. (1) Stereotactic radiation is considered a valuable treatment option, in particular for the advanced cases. (2) The RNA is recently modified, that is, slightly redefined by tilting the flanges of the applicator somewhat more laterally ( Fig. 1). This way, it is found to be easier to push the dose laterally into the parapharyngeal space to an adequate dose level. (3) The dose can be prescribed more accurately.