Combined Modality Treatment in Nasopharyngeal Carcinoma

Yun, Sang Mo; Kim, Jae Cheol; Park, In Kyu

Abstract

PURPOSE: We performed a retrospective analysis to compare short term results of induction chemotherapy-radiotherapy versus concurrent chemo-radiotherapy in patients with locally advanced nasopharyngeal carcinoma.
MATERIALS AND METHODS
From Oct. 1989 to May 1998, 62 patients with locally advanced nasopharyngeal carcinoma were treated with induction chemotherapy followed by radiotherapy (induction group) or concurrent chemo-radiotherapy (concurrent group). Induction chemotherapy was done for 50 patients, and concurrent chemotherapy for 12 patients. Age, sex, performance status, and pathologic types were evenly distributed between two groups. Stage distribution showed 32% with IIB, 30% with III, and 38% with IV in induction group, and 50%, 33.3%, and 16.7% in concurrent group, respectively. Chemotherapy regimen was CF (cisplatin and 5-FU) in both groups, and drug delivery method also same. Cisplatin 100 mg/m2 was intravenously infused on day 1, and 5-FU 1,000 mg/m2 on day 2~6. This was repeated at 3 weeks interval. At the end of radiotherapy, total cycles of chemotherapy were 1~3 (median 2) in both groups. Conventionally fractionated radiotherapy with daily fraction size 1.8~2.0 Gy and 5 fractions/week was done. Total dose was 69.4~86 Gy(median 73.4 Gy) for induction group, and 69.4~75.4 Gy (median 70.8 Gy) for concurrent group. Follow-up time was 9~116 months (median 40.5 months) for induction group, 14~29 months (median 21 months) for concurrent group, respectively.
RESULTS
Overall 2 year survival rate (2YSR) for all patients was 78.7%. According to treatment modality, 2YSR were 77% for induction group, 87% for concurrent group (p>0.05). 2 year disease-free survival rate were 56% and 81% (p>0.05), respectively. Complete response to treatment were 75.5% for induction group and 91.7% for concurrent group, but there was no statistical difference. The incidence of grade 3~4 hematologic toxicity during radiotherapy was not differ between two groups, but grade 2 leukopenia was more frequent in concurrent group (18% vs 66.7%). Grade 3~4 mucositis was more frequent in concurrent group (4.0% vs 33.3%). Overall incidence of grade 3~4 acute toxicity during radiotherapy was more frequent in concurrent group (6.0% vs 41.7%, p=0.005).
CONCLUSION
Concurrent chemo-radiotherapy showed a trend of improvement in short-term survival and in treatment response when compared with induction chemotherapy-radiotherapy in locally advanced nasopharyngeal carcinoma. More controlled randomized trial are needed.