الفهرس 
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Abstract
The role of induction chemotherapy prior to CCRT in treatment of locally advanced nasopharyngeal cancer has not been determined yet .we conducted this phase II study to evaluate the efficacy and safety of induction chemotherapeutic (TPF) regimen prior to CCRT with cisplatin weekly in locally advanced non metastatic NPC .Methods : Stage III, IVA &IVB, poorly differentiated or undifferentiated carcinoma were included. We included 36 patients ; all of them received induction chemotherapy with TPF regimen followed by cisplatin (40 mg/m2) weekly concurrent with R. Radiotherapy was given by 3D conformal modality where ,high risk GTVP, GTVLN & CTV was given a dose of 60 Gray / 30 fractions followed by 14 gray / 5-7 fractions to GTVP and 6-10 Gray / 3-5 fractions to GTVLN. Results : 34 patients were evaluable for treatment response with chemotherapy as they ended 3 courses of TPF and 32 patients were evaluable for overall treatment response with CRT. The objective response rate was 86% ( CR 12%) in the primary tumor and 100% (CR 62%) in the cervical LN after induction chemotherapy and the corresponding rate was 100 % ( CR 91% ) ,45-60 days after the completion of RT .No local recurrence or distant metastasis were seen during the follow up period . The 2 year DFS was 85% and the estimated 2 year OS was 95% .The rate of grade 3 /4 neutropenic fever was encountered in 6% of cases during induction chemotherapy. Grade 3/4 mucositis was seen in 9 % of patients while no grade 3 or 4 skin desquamation or xerostomia were seen. There was no treatment related death. Field in field technique technique gave best coverage of the PTV without exceeding the tolerance dose of other OAR. Conclusion :The TPF regimen was well tolerated and had a manageable toxicity profile. 3DCRT can be tailored to reach the target of Intensity modulation modalities.