Regular Article

British Journal of Cancer (2000) 83, 1437–1442. doi:10.1054/bjoc.2000.1485 www.bjcancer.com
Published online 14 November 2000

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

M Benasso1, G Sanguineti2, M D'Amico1, R Corvò2, I Ricci1, G Numico3, D Guarneri1, V Vitale2, E Pallestrini5, A Santelli5 and R Rosso1

  1. 1Department of Medical Oncology I, Istituto Nazionale per la Ricerca sul Cancro, Genova
  2. 2Department of Radiation Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genova
  3. 3Department of Medical Oncology, Ospedale S. Croce e Carle, Cuneo
  4. 4Department of Medical Oncology, Ospedale Sanremo
  5. 5Department of Otolaryngology, Ospedale S. Martino, Genova

Received 25 February 2000; Revised 25 July 2000; Accepted 9 August 2000.

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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

Keywords:

nasopharyngeal carcinoma, chemo-radiotherapy, combined treatments

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