Cancer Res Treat.  2008 Dec;40(4):155-163.

Radiation Therapy Combined with (or without) Cisplatin-based Chemotherapy for Patients with Nasopharyngeal Cancer: 15-years Experience of a Single Institution in Korea

• Kim YS
• Kim BS
• Jung SL
• Lee YS
• Kim MS
• Sun DI
• Yoo EJ
• Mun SK
• Yoon SC
• Chung SM
• Kim HK
• Jo SH
• Kang JH

Abstract

PURPOSE: This retrospective study was carried out to evaluate the efficacy and toxicity of radiation therapy (RT) with/without cisplatin-based chemotherapy in nasopharyngeal cancer (NPC).
MATERIALS AND METHODS
One hundred forty six patients with NPC received curative RT and/or cisplatin-based chemotherapy. Thirty-nine patients were treated with induction chemotherapy (IC), including cisplatin and 5-fluorouracil followed by RT. Another 63 patients were treated with concurrent chemoradiotherapy (CCRT) using cisplatin, and 22 patients were treated with IC followed by CCRT. The remaining 22 patients were treated with RT alone.
RESULTS
One hundred four (80.0%) patients achieved complete response (CR), and 23 (17.7%) patients achieved partial response (PR). The patterns of failure were: locoregional recurrences in 21.2% and distant metastases in 17.1%. Five-year overall survival (OS) and progression free survival (PFS) were 50.7% and 45.0%, respectively. Multivariate Cox stepwise regression analysis revealed CR to chemoradiotherapy to be a powerful prognostic factor for OS. CR to chemoradiotherapy and completion of radiation according to the time schedule were favorable prognostic factors for PFS. A comparison of each treatment group (IC --> RT vs. CCRT vs. IC --> CCRT vs. RT alone) revealed no significant differences in the OS or PFS. However, subgroup analysis showed significant differences in both OS and DFS in favor of the combined chemoradiotherapy group compared with RT alone, for stage IV and T3-4 tumors. Grade 3-4 toxicities were more common in the combined chemoradiotherapy arm, particularly in the CCRT group.
CONCLUSIONS
This study was limited in that it was a retrospective study, much time was required to collect patients, and there were imbalances in the number of patients in each treatment group. Combined chemoradiotherapy remarkably prolonged the OS and PFS in subgroup patients with stage IV or T3-4 NPC.

Keyword

Nasopharyngeal cancer; Chemoradiotherapy; Cisplatin; Radiation; Combined therapy

MeSH Terms

Appointments and Schedules
Arm
Chemoradiotherapy
Cisplatin
Disease-Free Survival
Fluorouracil
Humans
Induction Chemotherapy
Korea
Nasopharyngeal Neoplasms
Neoplasm Metastasis
Recurrence
Retrospective Studies
Cisplatin
Fluorouracil

Figure

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  Fig. 1 Comparison of OS and PFS in the combined chemoradiotherapy arm (CRT, solid line) versus the radiotherapy alone arm (dashed line) in the T3 and T4 (A) and stage IV (B) subgroups. This figure demonstrates the benefit of CRT with regard to OS and PFS.

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  Fig. 2 Comparison of OS and PFS in patients who showed complete response to chemoradiotherapy (solid line) versus those who showed partial response to chemoradiotherapy (dashed line).

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  Fig. 3 Comparison of PFS in patients in whom RT was not prolonged more than 2 weeks (solid line) versus patients in whom RT was prolonged more than 2 weeks (dashed line).

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