Comparison of concurrent chemoradiotherapy versus induction chemotherapy followed by radiation in patients with nasopharyngeal carcinoma

Department of Otolaryngology, and Head and Neck Surgery, Yokohama City University School of Medicine, 9-3 Fukuura, Kanazawa-Ku, Yokohama 236-0004, Japan.
Anticancer research (Impact Factor: 1.83). 02/2012; 32(2):681-6.
Source: PubMed


The study aimed to evaluate the efficacy of concurrent chemoradiotherapy (CCRT) with platinum-based chemotherapy as a primary treatment for nasopharyngeal carcinoma (NPC) and to further compare the results of CCRT with these of neoadjuvant chemotherapy (NAC) followed by radiotherapy (RT).
Before 1998, 21 patients with NPC received NAC followed by RT (NAC-RT). Between 1999 and 2008, a total of 25 NPC patients received CCRT. The CCRT group received a regimen including docetaxel (50 mg/m(2), day1), cisplatin (CDDP, 60 mg/m(2), day4) and continuous 5-fluorouracil (5-FU) infusion (600 mg/m(2), day 1-5), the TPF regimen, or a regimen including CDDP (60 mg/m(2), day4), continuous 5-FU infusion (600 mg/m(2), day 1-5), methotrexate (MTX, 30 mg/m(2), day 1) and leucovorin (LV, 20 mg/m(2), day 1-5), PFML regimen. The CCRT group received 2 cycles of chemotherapy during definitive RT. The NAC group of patients received a PFML regimen.
The overall response rate after CCRT was 96%. The 3-year and 5-year disease-specific survival rates were 75.6% and 60.1%, respectively. In patients receiving NAC-RT, the 3-year and 5-year disease-specific survival rates were 84.1% and 67.3%, respectively. There was no difference observed in terms of survival rates between the group receiving CCRT and that receiving NAC-RT.
CCRT with the TPF or PFML regimen was tolerable, and the NPC patients receiving this treatment showed excellent survival rates. In comparison to the group receiving NAC-RT, CCRT had no advantage in terms of the survival rate. In the future, the control of distant metastasis might play an important role in improving the survival rate of patients with advanced NPC receiving CCRT.

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    • "Currently, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology recommend concurrent chemoradiotherapy for the treatment of locally advanced NPC (7,8,9). Studies of targeted therapies have been encouraging in recent years. "
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    • "Therapeutic strategies have been studied aiming to improve the survival rate for advanced NPC. Recently, novel therapies based on molecular targets and neoadjuvant chemotherapy (NAC) followed by RT of NPC were promising for advanced lesions [7,8], though need to be validated in more trials. Conventional TNM staging has a strong prognostic implication for NPC [9]; and patients at early-stage are almost curable under RT, however, the prognosis remains poor in a significant number of patients with late-stage NPC [10] . "
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