New Approaches for Locally Advanced Nasopharyngeal Carcinoma

Abstract

Objective: To evaluate 2 different schemes of neoadjuvant chemotherapy (NACT) followed by 2 different concomitant chemoradiotherapy (CHRT) schedules in loco-regionally advanced nasopharyngeal carcinoma (A-NPC) observed in a nonendemic population. Method: Seventy homogeneous patients affected by A-NPC were enrolled in this retrospective study. Forty patients (group A) underwent 3 cycles of NACT with cisplatin+epirubicin followed by cisplatin+70 Gy RT; and 30 patients (group B) received 3 cycles of NACT with carboplatin+taxol followed by weekly carboplatin+taxol for 7 weeks+concomitant 70Gy RT. Results: After NACT, results in group A and B were: CRs 30% vs 33%, PRs 60% vs 60%, NC 10% vs 6.6%; after CHRT: CRs 75% vs 87%, PRs 25% vs 13%. After median follow-up of 54 months (A) and 49 months (B), 3-5 years 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 years locoregional control was 70% vs 90%, and 5 years distant metastases–free survival was 75% vs 85%. NACT toxicity was as follows: G3-4 neutropenia 40% vs 83%, G3 thrombocytopenia 12% vs 13%, G3 anemia 0% vs 10% and G3 mucositis 2.5% vs 6.6%; CHRT toxicity was as follows: G3-G4 neutropenia 20% vs 63%; G3 anemia 2.5% vs 17%, G3-G4 mucositis 32.5% vs 69%; skin toxicity 25% vs 23% and G3 neurotoxicity 5% vs 10%. Conclusion: NACT followed by CHRT 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. Double drug CHRT in group B is characterized by higher incidence of acute toxicities without significant impact on major clinical outcomes.