Abstract
ObjectivesThe standard of care for locally advanced nasopharyngeal carcinoma (NPC) is concurrent cisplatin chemoradiotherapy. Neoadjuvant chemotherapy can be administered to downsize tumors before concurrent treatment to optimize radiation volumes. Our hypothesis was that the use of cisplatin in the neoadjuvant phase could limit the amount of cisplatin that patients could tolerate in the concurrent phase of treatment.MethodsThis is a retrospective analysis of Canadian NPC patients who received neoadjuvant chemotherapy with the intention to downsize locally advanced tumors prior to concurrent cisplatin plus radiation. Baseline demographic and treatment data were obtained from institutional databases and chart review; all data were analyzed with SPSS (SPSS Inc. Released 2005. SPSS for Windows, Version 14.0. Chicago: SPSS Inc.) Overall survival (OS), disease-specific survival (DSS), and local/regional relapse-free survival (LRRFS) were analyzed using Kaplan-Meier survival functions. Univariate and multivariate models were used to determine factors associated with the total dose of concurrent chemotherapy.ResultsForty-six patients were identified as receiving neoadjuvant chemotherapy before concurrent chemoradiotherapy. In the univariate and multivariate analyses of patients who received concurrent chemotherapy, receiving over 200 mg/m2 concurrent cisplatin with radiation was associated with a higher neoadjuvant dose of chemotherapy received. The median follow-up time was 2.6 years (range, 0.17 years to 10.6 years). At three years, the OS was 83%, DSS was 86%, and LRRFS was 74%.ConclusionsNPC patients have been treated with neoadjuvant chemotherapy at this center with favorable outcomes. Most patients could tolerate concurrent chemotherapy after radiotherapy. Receiving higher doses of concurrent chemotherapy was associated with also having higher doses of neoadjuvant cisplatin. This suggests that neoadjuvant cisplatin is not a limiting factor in the delivery of full-dose concurrent chemotherapy.
Highlights
Radiotherapy is the mainstay of treatment for nasopharyngeal carcinoma (NPC) [1,2]
Forty-six patients were identified as receiving neoadjuvant chemotherapy before concurrent chemoradiotherapy
NPC patients have been treated with neoadjuvant chemotherapy at this center with favorable outcomes
Summary
Radiotherapy is the mainstay of treatment for nasopharyngeal carcinoma (NPC) [1,2]. Doses of 70 Gy directed to the primary tumor and involved lymph nodes have been recognized as a curative treatment protocol. In the locally advanced setting, concurrent chemoradiotherapy is the standard of care based on Phase III trials conducted in both North America and Asia that demonstrated a significant survival benefit [3,4]. Neoadjuvant chemotherapy has been used for locally advanced presentations of NPC. The proposed benefits of neoadjuvant chemotherapy in this setting are to downsize the tumor prior to radiation and to treat microscopic metastatic disease. Downsizing from neoadjuvant chemotherapy may help shrink the tumor away from dose-limiting critical structures and, facilitate radiation delivery and reduce the risk of significant morbidity or even mortality
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