Comparison of two schedules in locally advanced nasopharyngeal carcinoma observed in a nonendemic population.

Abstract

5542 Background: Aim of this study was the clinical evaluation of two different schemes of neoadjuvant chemotherapy (NACT) followed by two different concomitant chemoradiotherapy (CHRT) schedules in loco-regionally advanced nasopharyngeal carcinoma (A-NPC) observed in a non endemic population and treated in the same institution. Methods: Seventy patients (51M, 19F; median age: 53.5 yrs; ECOG PS: 0 -63 pts; 1 - 7 pts; 63 pts type 3 and 7 pts type 2 WHO histology; 36 pts stage III, 28 pts stage IVa and 6 pts IVb, 47 pts N2/N3 AJCC TNM 7th ed) were enrolled. Forty pts (group A) were treated with 3 cycles of NACT with cisplatin (100 mg/m2, d.1) + epirubicin (90 mg/m2, d.1) q 3wks, followed by cisplatin (100 mg/m2, d. 1,22,43) and concomitant 70 Gy RT; 30 (group B) received 3 cycles of NACT with carboplatin (AUC6, d.1 ) + taxol (175mg/m2, d.1), q 3 wks, followed by weekly carboplatin (AUC1) + taxol (60mg/m2) for seven wks and concomitant 70Gy RT. Clinical and pathological characteristics in group A and B were strictly superimposeable. Results: After IC results in group A and B were respectively : CRs 30 % vs 33%, PRs 60% vs 60%, NC 10% vs 6.6% ; after CHRT: CRs 75% vs 87%, PRs 25% vs 13%. After a median follow-up of 54 months (A) and 49 months (B): 3 and 5 yrs progression free survival were 75% vs 80% and 65% vs 75% respectively and overall survival was 84% vs 85% and 77% vs 80% respectively; 5 yrs locoregional control was 70% vs 90% and 5 yrs distant metastases free survival was 75% vs 85%. IC toxicity was as follows: G3-4 neutropenia 40% vs 83%, G3 thrombocytopenia 12% vs 13%, G3 anaemia 0% vs 10% and G3 mucositis 2.5 vs 6.6%; CHRT toxicity was as follows: G3-G4 neutropenia 20% vs 63%; G3 thrombocytopenia 10% vs 7.5%; G3 anaemia 2.5% vs 17%, G3-G4 mucositis 32.5% vs 69%; skin toxicity 25% vs 23% and G3 neurotoxicity 5% vs 10%. Conclusions: NACT followed by concomitant CHT represents a feasible, highly effective treatment for patients with A-NPC, with excellent locoregional disease control and overall survival and with low incidence of distant metastases. Higher incidence of acute toxicities was observed in group B, without a significant impact on major clinical outcomes. Group A treatment seems feasible with a good safety profile.