Long-Term Disease-Free Survivors in Metastatic Undifferentiated Carcinoma of Nasopharyngeal Type

Abstract

PURPOSE: To review incidence and analyze profile of long-term complete responders among patients with undifferentiated carcinoma of nasopharyngeal type (UCNT) treated at a single institution. PATIENTS AND METHODS: We present a cohort of 20 long-term unmaintained complete responders to chemotherapy for metastatic UCNT treated at the Institut Gustave Roussy between April 1978 and November 1996. A patient was considered a long-term survivor if he or she was disease-free for more than 36 months without treatment after obtaining a complete response by chemotherapy. Patient characteristics were as follows: sex, 17 men and three women; median age, 28 years (range, 9 to 62 years); median World Health Organization performance status, 1; and initial tumor-node-metastasis stage (International Union Against Cancer–American Joint Committee on Cancer, 1987) of T3 to T4, 60%, and of N2b to N3, 75%. Epstein-Barr virus serology was characteristic in 19 patients. Of 16 pretreated patients, 11 were pretreated by radiotherapy alone and five by chemotherapy and radiotherapy. Thirteen patients had metastatic relapses of locally controlled UCNT. Tumor sites were bone in 15 patients, lung in four, and liver (biopsy-proven) in two. Chemotherapy included the following: cisplatin, bleomycin, and fluorouracil in five patients; bleomycin, epirubicin, and cisplatin in seven patients; fluorouracil, mitomycin, epirubicin, and cisplatin in four patients; and fluorouracil, bleomycin, epirubicin, and cisplatin in one patient. Three patients were treated with platinum-based regimens before 1985. Patients received a median of six cycles (range, three to 13). Thirteen patients with bone metastases received consolidating radiotherapy. RESULTS: As of June 1999, 14 of 20 patients were still alive with no evidence of disease after treatment (disease-free survival time, 82+ to 190+ months), three patients died of other causes while in complete response at 61, 109, and 208 months after treatment, and three patients died of disease at 42, 89, and 115 months after treatment. Long-term complete responses were obtained in both bone and visceral disease. CONCLUSION: Our data support a curative role for chemotherapy in metastatic UCNT and are a major incentive to continue research for better combinations to increase the percentage of patients with metastatic UCNT who attain complete responses and long-term survival.

Validation of a new prognostic index score for disseminated nasopharyngeal carcinoma

“…In fact, one patient survived 8 years 7 months while another three lived beyond 4 years after diagnosis of metastatic disease. A number of studies have reported similar findings, with several long-term survivors with the use of chemotherapy in metastatic NPC (Chan et al, 1997;Fandi et al, 2000). Based on the results of our studies, it is possible for single-arm studies or randomised studies that are inadequately powered or stratified to report spuriously improved survival outcome with a new therapeutic intervention because of biased patient selection alone.…”

Paediatric Nasopharyngeal Carcinoma: An 8-Year Study from a Tertiary Care Cancer Centre in South India

“…In our study metastatic disease had significantly poor prognostic outcome (p \ 0.001). This finding was similar to other studies [9][10][11][12]. Significant survival advantage was seen in patients receiving higher total radiotherapy dose ([66 Gy), which was similar to other studies [13,14].…”

Prognostic Factors on Overall Survival of Newly Diagnosed Metastatic Nasopharyngeal Carcinoma

“…Although the prognosis of metastatic NPC is still quite poor, it has been well accepted that the survival can be highly variable and long-term survival is possible in some patients (Teo et al, 1996;Fandi et al, 2000;Khanfir et al, 2006). But most of the reports included patients who developed metastasis (es) after primary treatment, few explored the prognosis of newly diagnosed metastatic NPC specially.…”