Concurrent chemoradiotherapy (chemoRT) for nasopharyngeal carcinoma (NPC): 10-year experience at a single institute

Abstract

5573 Background: Radical treatment of NPC consists of radiotherapy (RT) ± chemotherapy. The ideal chemotherapy regimen to be given with RT is unknown. We report our institute's experience with radical treatment of NPC. Methods: Seventy-nine NPC patients were treated radically at the Tom Baker Cancer Centre (TBCC) between 1992–2002. Their charts were reviewed for initial patient characteristics, treatment given, rate of grade 3–4 acute and late toxicities according to the Radiation Therapy Oncology Group (RTOG) scales, failure patterns and causes of death. Data was analyzed using Intercooled Stata 8 (Stata Corporation, College Station, TX). Kaplan Meier estimates of 3-year overall and disease-free survival (OS, DFS) were calculated. Results: The majority of patients (63.3%) had stage III-IVb disease. Mean RT dose to gross disease was 67.9 Gy and mean treatment time was 50.7 days. Patients were treated with one of three different regimens: RT alone (n=18), RT with concurrent carboplatin, 100 mg/m2 weekly X 5 doses (n=45) or RT with concurrent cisplatin, 20 mg/m2 weeks 1 & 5 of RT (n=16). 94.4%, 80.0%, and 81.2% of each group received all prescribed treatments, respectively. With a mean follow-up of 65 months, the 3-year estimate of DFS in each group was 54.4%, 64.4%, and 73.3%, respectively. With a mean follow-up of 88 months, the 3-year estimate of OS in each group was 49.9%, 67.9% and 70.2%, respectively. Maximal rates of RTOG acute grade 3–4 toxicities were 38.9%, 48.9% and 31.3% respectively. Five patients (6.3%) had late grade 3–4 toxicities. There were no treatment-related deaths. 25.3% of patients were hospitalized during treatment and 71.6% lost =< 9.9% of their pre-treatment weight. Most failures were locoregional (57.1%) with a significant proportion being distant (42.9%). The majority of deaths were NPC-related (90.3%). Conclusions: At the TBCC, concurrent chemoRT for NPC confers a trend for improved DFS and OS compared with RT alone. Toxicity rates in NPC patients receiving concurrent chemoRT were acceptable. No significant financial relationships to disclose.