Complete clinical response after induction chemotherapy followed by chemoradiotherapy in nasopharyngeal carcinoma: Impact on oncologic outcomes

Abstract

Objective: Concomitant chemoradiation (RCT) represents the standard of care for locally-advanced nasopharyngeal carcinoma (NPC). Nevertheless, induction chemotherapy (IC) followed by RCT could be an interesting approach. Some trials showed a survival benefit of this therapeutic strategy, but it is not the standard of care. The aim of this study was to analyze clinical response after IC and to assess its impact on disease control and survival. Materials and methods:We conducted a retrospective study from January 2008 to December 2014. Forty patients with locally advanced NPC were treated in our institute. All patients received IC with fluorouracyl-cisplatin (5 FU-CDDP) or fluorouracyl-cisplatin-Docetaxel (TPF) or Adriamycin-cisplatin (AD-CDDP). After IC, clinical response was evaluated, CCR was defined by a normal clinical and computed tomography examination. After IC, 14 patients received RCT and 22 patients received radiotherapy (RT) alone.Results: Our study included 25 men and 15 women with a median age of 41years. Tumor was classified T1 in 5% of patients, T2 in 27%, T3 in 20% and T4 in 48%. 80% of patients had involved nodes (N+). Twenty patients received 5FU-CDDP, 16 received TPF and 4 received AD-CDDP. The occurrence of leucopenia was higher in the 5FU-CDDP (p=0.02) group. Gastrointestinal toxicity was higher in the TPF group (p=0.01). Anemia and thrombopenia were similar in the three groups. After IC, 18 patients (45%) achieved CCR, 7 of them had RCT and 11 had RT alone. 21patients (52%) achieved partial clinical response (PR) and 1 patient developed metastases. The CCR was higher in (5FU-CDDP) group (p>0.3). CCR followed by RCT was associated to better local control than RT alone. However, there was no benefit in overall survival in the CCR group compared to partial clinical response (PR). Conclusion:Complete clinical response after IC followed by RCT in locally-advanced nasopharyngeal carcinoma is associated to a better local disease control without impact on survival.