Limitations
tumors
TUMORS
A limitation of this study was the small, nonrandomized sample size of 44 patients with locoregionally advanced NPC. Nonetheless, our findings suggest that VEGF inhibition may be combined safely with standard chemoradiation. We did not observe excessive rates of toxic effects with this combination even when tumors were close to major blood vessels, which is almost always the case for locoregionally advanced NPC. Another limitation was that the staging system for NPC has changed since the completion of this study. Given that our primary end point was safety and toxic effects, we do not believe that the change in the staging system would be associated with changes in our end point. Furthermore, 10 patients in the entire cohort may possibly be downstaged given the change in the staging system since the completion of this study, and therefore, we do not feel that excellent treatment outcomes were purely outcomes associated with staging migration from T4 (AJCC Staging Manual, 7th Edition) to T2 (AJCC Staging Manual, 8th Edition).