1143P - Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC)

Abstract

BackgroundCurrent treatment of locoregionally advanced NPC (LRA-NPC) is CCRT with or without adjuvant chemotherapy (CT). The value of adding IC to CCRT in LRA-NPC is unclear. We retrospectively evaluated LRA-NPC patients treated with IC followed by CCRT in a single tertiary center in Turkey. MethodsBetween 2004 and 2016, 202 patients with nonmetastatic LRA-NPC (stage 3-4), 144 males and 58 females ranging from 17 to 75 (median 49) years old, were treated with IC followed by CCRT. Eleven (%5.4) patients had keratinised (WHO I), and 191 (%94.6) had nonkeratinised or undiffrentiated (WHO II-III) carcinoma. Cumulative radiation dose to primary tumor ranged from 60 to 74 (median 70) Gy. Ninety-one (%45) of the patients received 2-dimensional and 111 (%55) received intensity modulated radiotherapy (IMRT). IC consisted of taxane (T)(75mg/ m2) and platinum (P)(75mg/m2) combination (199 patients) or P and fluorouracil or epirubicine (3 patients) combination and 188 of the patients received 3 cycles of IC. Concomittant P was used either weekly (40mg/m2, 25 patients) or every 3-weekly (100mg/m2, 177 patients) application. Follow-up ranged from 5 to 167 months (median, 72.5 months).Table: 1143PTable: 1143PPatient and treatment characteristicsn ( % )StageIII IVA IVB149 (73.7%) 30 (14.9%) 23 (11.4%)Number of induction courses2 3 410 (5%) 188 (93.1%) 4 (2%)Concomittant typeEvery 3 weeks (100mg/m2) Every week (40mg/m2)177 (87.6%) 25 (12.4%)RT technique2-dimensional Intensity modulated91 (45%) 111 (55%)Radiation dose to primary (Gy)≤ 70 > 708 (4%) 194 (96%) ResultsTreatment failure was observed in 52 (%25.7) of the patients (21 local, 13 regional and 27 distant). Distant failure rate of all the patients exceeds 13%. Five and 10 years disease free survival (DFS) rates are 75.2% and 70.4% and overall survival (OS) rates are 78.9% and 64% respectively. In univariate analysis patient age favoring those below 49 and stage of disease favoring WHO II-III were all significant predictors of DFS and OS. In addition pathology was a significant predictor of DFS. ConclusionsLRA-NPC patients treated with IC followed by CCRT have a high locoregional control (LRC) rate. Despite the use of IC distant control remains insufficient and continues to be a challenge in NPC. Besides improving LRC, more effective systemic therapy is needed. Legal entity responsible for the studyMusa Altun, MD. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.