Induction chemotherapy followed by alternating chemo-radiotherapy in stage IV undifferentiated nasopharyngeal carcinoma

Abstract

In locally advanced undifferentiated nasopharyngeal carcinoma (UNPC), concomitant chemo-radiotherapy is the only strategy that gave better results over radiation alone in a phase III trial. Adding effective chemotherapy to a concomitant chemo-radiotherapy programme may be a way to improve the results further. 30 patients with previously untreated T4 and/or N2–3 undifferentiated nasopharyngeal carcinoma were consecutively enrolled and initially treated with 3 courses of epidoxorubicin, 90 mg/m2, day 1 and cisplatin, 40 mg/m2, days 1 and 2, every 3 weeks. After a radiological and clinical response assessment patients underwent 3 courses of cisplatin, 20 mg/m2/day, days 1–4 and fluorouracil, 200 mg/m2/day, days 1–4, i.v. bolus, (weeks 1, 4, 7) alternated to 3 courses of radiation (week 2–3, 5–6, 8–9–10), with a single daily fractionation, up to 70 Gy. WHO histology was type 2 in 30% and type 3 in 70% of the patients. 57% had T4 and 77% N2–3 disease. All the patients are evaluable for toxicity and response. All but one received 3 courses of induction chemotherapy. Toxicity was mild to moderate in any case. At the end of the induction phase 10% of CRs, 83.3% of PRs and 6.7% of SD were recorded. All the patients but one had the planned number of chemotherapy courses in the alternating phase and all received the planned radiation dose. One patient out of 3 developed grade III–IV mucositis. Haematological toxicity was generally mild to moderate. At the final response evaluation 86.7% of CRs and 13.3% of PRs were observed. At a median follow-up of 31 months, 13.3% of patients had a loco-regional progression and 20% developed distant metastases. The 3-year actuarial progression-free survival and overall survival rates were 64% and 83%. Induction chemotherapy followed by alternating chemo-radiotherapy is feasible and patients' compliance optimal. This approach showed a very promising activity on locally advanced UNPC and merits to be investigated in phase III studies. © 2000 Cancer Research Campaign http://www.bjcancer.com

How we wrote a landmark nasopharyngeal intergroup phase III protocol in North America

“…The incidence of systemic metastasis at presentation or after failure of the local treatment(s) was higher than observed in other head and neck (H&N) cancer sites. We knew that NPC is highly sensitive to radiotherapy and had begun to think that it was also sensitive to chemotherapy [3][4][5][6][7][8][9]. RT had been the mainstay of the management of locally advanced nasopharyngeal cancers (stages III and IV), and while the results of RT in patients who had stage IV disease was somewhat better than seen in other H&N cancers, the results were still disappointing.…”

Lymphoepithelial carcinoma of the head and neck: a SEER analysis of prognostic factors for survival

“…After 1985, clinical trials of radiotherapy combined with chemotherapy were gradually reported. 18 – 21 In the meantime, the methods of radiotherapy have been further improved, and radiation techniques have been perfected. 22 , 23 In addition, patient compliance and the rate of diagnosis might be additional factors.…”

Alternating Combination Chemotherapy and Radiotherapy in Locoregionally Advanced Head and Neck Cancer

“…Alternating chemoradiotherapy in locally advanced HNC, regardless of the chemotherapy regimens is more likely to be associated with complete response 16 . To increase the response of ACR induction chemotherapy was given before it as in the study done by Benasso et al 17 who reported CR86.7%, PR13.3%, 3years DFS and OS, 64% and 83%, respectively.…”