Induction chemotherapy (CTX) followed by concurrent chemoradiotherapy (CRT) in patients (pts) with nasopharyngeal cancer (NPC)

Abstract

5598 Background: A randomized trial has demonstrated that concurrent CRT is superior to radiotherapy (RT) alone in advanced NPC (Intergroup 0099, J Clin Oncol 16:1310, 1998). Methods: Between October 1996 and October 2001, we treated 35 pts with NPC (stage I: 1, II: 12, III: 7, IV: 15) with 1 cycle of induction CTX (5-fluorouracil 1000 mg/m2 D1–4, cisplatin 20 mg/m2 D1–4) followed by concurrent CRT starting on day 22. CRT consisted of RT (7020 cGy at 180 cGy/day) with concurrent cisplatin 20 mg/m2 on D22–25, D43–46, and D64–67. Results: Based on post-treatment imaging, complete response (CR) was achieved in 33 pts (94%), partial response in 1 pt, and one pt demonstrated progressive disease. Among pts with CR, 11 pts recurred: 6 locoregional, 5 distant. Twelve pts died, 10 with recurrence or disease progression, 1 with radiation induced brain necrosis, and 1 from unknown cause. Four-year progression-free survival and overall survival of total pts were 59% and 64%, respectively, with 46 months median follow-up in survivors. Major toxicities were oral mucositis (grade 3 or 4: 20 pts), radiation dermatitis (grade 3: 11 pts), and leukopenia (grade 3: 6 pts). Furthermore, thirty-one patients (89%) experienced at least one type of otototoxicity: otitis media (27 pts), sensorineural and/or conductive hearing loss (21 pts), external otitis (7 pts), tinnitus (5 pts). Conclusions: The outcome of pts treated with this combined modality therapy appears to be comparable with that of Intergroup 0099 trial with high CR rate. In addition, ototoxicity seems to be a very frequent and clinically significant complication of CRT for NPC. No significant financial relationships to disclose.