A prospective study on therapeutic gain by concurrent chemoradiotherapy for stage II–IV a nasopharyngeal carcinoma

Abstract

The benefit achieved by concurrent chemoradiotherapy (CCR) and sequential chemoradiotherapy (SCR) vs radiotherapy (RT) alone for patients with stage II–IVa nasopharyngeal carcinoma (NPC) was compared. A total of 113 patients with stage II–IV a NPC were allotted into CCR group (n=38), SCR group (n=36) and RT alone group (n=39). All patients were irradiated with the same RT technique to ≥66 Gy at 2 Gy per fraction, conventional 5 fractions/week in all groups. The CCR group received concurrent chemotherapy of weekly cisplatin for 7 weeks, and the SCR group received neoadjuvant and (or) adjuvant chemotherapy. The results showed that the 3- and 5-year overall survival rate was significantly higher in CCR group than in RT alone group (92.16% vs 61.54%, 81.58% vs 51.28%, P<0.005). The median survival time was significantly longer in CCR group than in RT alone group (67.8 months vs 52.7 months, P<0.005). It was concluded that CCR could significantly improve overall survival rate, progression-free survival rate, and median survival time when compared with RT alone.

Keywords

nasopharyngeal carcinoma / radiotherapy / concurrent chemotherapy / sequential chemotherapy / long-term survival

References

[1] GuigayJ., TemamS., BourhisJ., et al.. Nasopharyngeal carcinoma and therapeutic management: the place of chemotherapy. Ann Oncol, 2006, 17(Suppl10): x304-x307

[2] PosnerM.R., HershockD.M., BlajmanC.R., et al.. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med, 2007, 357(17): 1705-1715

[3] O’MearaW.P., LeeN.. Advances in nasopharyngeal carcinoma. Curr Opin Oncol, 2005, 17(3): 225-230

[4] ChiK.H., ChangY., GuoW., et al.. A phase III study of adjuvant chemotherapy in advanced stage nasopharyngeal carcinoma patients. Int J Radiat Oncol Biol Phys, 2002, 52(5): 1238-1244

[5] CvitkovicE., EschwegeF., RahalM., et al.. Preliminary results of trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage IV (N2, M0) undifferentiated nasopharyngeal carcinoma: a positive effect on progression free survival. Int J Radiat Oncol Biol Phys, 1996, 35(3): 463-469

[6] ChuaD.T., ShamJ.S., ChoyD., et al.. Preliminary report of the Asian-Oceanian Clinical Oncology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Cancer, 1998, 83(11): 2270-2283

[7] MaJ., MaiH.Q., HongM.H., et al.. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol, 2001, 19(5): 1350-1357

[8] HaeryamaM., SakataK., ShiratoH., et al.. A prospective randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in advanced nasopharyngeal carcinoma. Cancer, 2002, 94(8): 2217-2223

[9] MaB.B., ChanA.T.. Recent perspectives in the role of chemotherapy in the management of advanced nasopharyngeal carcinoma. Cancer, 2005, 103(1): 22-31

[10] LangendijkJ.A., LeemansC.R., ButerJ., et al.. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol, 2004, 22(22): 4604-4612

[11] KwongD.L., ShamJ.S., AuG.K., et al.. Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J Clin Oncol, 2004, 22(13): 2643-2653

[12] OhJ.L., VokesE.E., KiesM.S., et al.. Induction chemotherapy followed by concomitant chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal cancer. Ann Oncol, 2003, 14(4): 564-569

[13] PrasadU., WahidM.I., JalaludinM.A., et al.. Long-term survival of nasopharyngeal carcinoma patients treated with adjuvant chemotherapy subsequent to conventional radical radiotherapy. Int J Radiat Oncol Biol Phys, 2002, 53(3): 648-655

[14] KwongD.L., ShamJ.S., LeungL.H., et al.. Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys, 2006, 64(2): 374-381

[15] RischinD., CorryJ., SmithJ., et al.. Excellent disease control and survival in patients with advanced nasopharyngeal cancer treated with chemoradiation. J Clin Oncol, 2002, 20(7): 1845-1852

[16] HuiE.P., MaB.B., LeungS.F., et al.. Efficacy of neoadjuvant docetaxel and cisplatin followed by concurrent cisplatin-radiotherapy in locally advanced nasopharyngeal carcinoma (NPC): a randomized phase II study. J Clin Oncol, 2007, 25(Suppl18): 308S

[17] ChanA.T., MaB.B., LoY.M., et al.. Phase II study of neoadjuvant carboplatin and paclitaxel followed by radiotherapy and concurrent cisplatin in patients with locoregionally advanced nasopharyngeal carcinoma: therapeutic monitoring with plasma Epstein-Barr virus DNA. J Clin Oncol, 2004, 22(15): 3053-3060