Sequential Chemotherapy and Radiation Therapy for Advanced Nasopharyngeal Carcinoma

Park, In Kyu; Kim, Sang Bo; Yun, Sang Mo; Kim, Jae Cheol; Park, Jun Sik

Abstract

Between January 1985 and July 1592, 52 patients with locally advanced nasopharyngeal carcinoma were studied retrospectively for the effectiveness of sequential chemotherapy and radiation therapy. The male to female ratio was 3.3:1 with a median age of 41 years. Forty patients had squamous cell carcinoma and the remaining 12 had undifferentiated carcinoma. Seven patients had stage III disease and the remainder had stage IV disease at time of presentation. All patients were treated two courses of chemotherapy followed by radiation therapy Chemotherapy consisted of either CVB(cisplatin, vincristine and bleomycin) of CF(cisplatin and 5-FU). Total radiation dose to the primary site ranged from 6000 cGy to 7500 cGy. Neck nodes were given booster treatment to maximum of 7000 cGy, depending on the extent of disease. Local control, overall survival and disease-free survival rates were analyzed. The complete response(CR) rate to chemotherapy was 15%, and the partial response(PR) rate was 46% for overall major response rate of 61%. The CR rate was 87% after radiation therapy. Median follow-up time was 51 months. The overall survival and disease-free survival rates at 36 months were 54% and 49%, respectively. Median time to relapse was 15 months. The patterns of initial relapse in CR patients was as follows: locoregional failure only, 12 patients; distant metastasis only, 11; both, 2. Cox's multivariate regression model revealed that nodal status was the single most important independent prognostic factor influencing disease-free survival(p=0.001). Comparison of these results with other published reports with radiation therapy alone showed that a high rate of initial response to chemotherapy did not translate into local control or survival. At present time radiation therapy alone remains the standard treatment for locoregional cancer of the nasopharyngeal cancer. More controlled clinical trials must be completed before acceptance of chemotherapy as a part of treatment of advanced nasopharyngeal carcinoma.