Induction chemotherapy followed by concomitant chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal cancer

• Published in: Annals of oncology Vol. 14; no. 4; pp. 564 - 569
• Main Authors: Oh, J. L., Vokes, E. E., Kies, M. S., Mittal, B. B., Witt, M. E., Weichselbaum, R. R., Haraf, D. J.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2003
• Subjects: Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma - drug therapy; Carcinoma - pathology; Carcinoma - radiotherapy; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Cisplatin - administration & dosage; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease-Free Survival; Female; Fluorouracil - administration & dosage; Humans; Hydroxyurea - administration & dosage; induction chemotherapy; Interferon-alpha - administration & dosage; Key words: concomitant chemoradiation therapy; Leucovorin - administration & dosage; Male; Medical sciences; Middle Aged; nasopharyngeal cancer; Nasopharyngeal Neoplasms - drug therapy; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - radiotherapy; Neoadjuvant Therapy; Neoplasm Staging; Pharmacology. Drug treatments; Treatment Outcome; Antineoplastic agent; Human; concomitant chemoradiation therapy; Nasopharynx; nasopharyngeal cancer; Malignant tumor; Radiotherapy; Chemoradiotherapy; Induction treatment; Chemotherapy; Treatment; ENT disease; Clinical trial; Advanced stage; Pharynx disease; Combined treatment; Treatment planning; induction chemotherapy
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdg163

Background: Since 1990, we have treated patients with advanced nasopharyngeal cancer with induction chemotherapy and concomitant chemoradiotherapy. We herein report the results of our experience. Patients and methods: From 1990 to 1999, 27 patients with locoregionally advanced nasopharyngeal cancer were treated with induction chemotherapy followed by concomitant chemoradiotherapy. Using the American Joint Committee on Cancer’s 1992 stage classification, all patients were stage III (11%) or IV (89%). By histology, 63% were poorly differentiated carcinoma and 37% squamous cell carcinoma. The median age was 42 years. Three cycles of induction chemotherapy consisting of cisplatin, 5-fluorouracil, leucovorin and interferon-α2b were administered, followed by concomitant chemoradiotherapy consisting of seven cycles of 5-fluorouracil, hydroxyurea and once-daily radiotherapy (FHX) on a week-on week-off schedule. The median radiotherapy dose was 70 Gy. Results: Clinical response to induction chemotherapy was 100%, 54.2% complete response (CR) and 45.8% partial response. Clinical and/or pathological (37% of all patients had post-treatment biopsy with or without neck dissection) CR after FHX was 100%. At a median follow-up of 52 months, three failures were observed. Two patients have died of disease, one of local failure and one of distant metastases. One patient is alive with an isolated rib metastasis. At 5 years, actuarial locoregional control is 93% and actuarial distant control 92%. The overall survival at 3 and 5 years is 88% and 77%, respectively. Four patients died of unrelated illnesses and had no evidence of disease with respect to their nasopharyngeal cancer. The progression-free survival at 3 and 5 years is 92% and 86%, respectively. Thirty-three per cent of patients required a reduction in the chemotherapy dose due to acute toxicity. Chronic toxicity was not observed, with all patients able to eat orally without dietary restrictions. Conclusions: Treatment of locoregionally advanced nasopharyngeal cancer with induction chemotherapy followed by concomitant chemoradiotherapy resulted in excellent overall survival with acceptable toxicity. These results are encouraging and warrant further investigation of intensified approaches.