Control of Regional Metastasis after Induction Chemotherapy and Radiotherapy for Nasopharyngeal Carcinoma
Ryan Smith, MD
University of Pennsylvania Cancer Center
Last Modified: November 5, 2001
Presenter: D. Chua
Affiliation: Queen Mary Hospital, The University of Hong Knog
Type of Session: Scientific
Nasopharyngeal cancer has a high incidence of metastases.
The evidence of regional nodal meastases may be the most important prognosticator of distant meastases and survival
This study was done to determine if adding induction chemotherapy to radiotherapy has an impact on the control of regional metastases and survival in patients with nasopharyngeal cancer.
A total of 240 patients were recruited onto 2 randomized trials comparing induction chemotherapy followed by radiation to radiation alone.
A total of 210 patients had cervical nodal metastases and were included in the analysis. 85% of these had N2 or N3 diseasae
All were WHO class III NP CA
Treatment consisted of 2-3 cycles of cisplatin (60 mg/m2) + epirubicin (110 mg/m2) q 3 weeks followed by radiation (2.5-3.5 Gy/day to 65-75 Gy) (or XRT alone).
Median FU was 71 months
86% of patients had a response to chemotherapy (CR in 44%, PR in 42%)
Total of 21% had regional failure (16% in CRT arm, 25% in XRT alone arm)
Surgical salvage was achieved in 41% and 46% of the groups, so after surgery, LR control was approximately 90% in each group (p=NS)
In patients with nodal size >6 cm, relapse free survival was 84% in the CRT group compared to 64% in the XRT alone group (p=.10)
There was no difference in the development of distant metastases between groups
5 year DSS was 66% and 68% in the two groups
Induction chemotherapy has a high response rate, but does not enhance long term regional nodal control, does not reduce distant metastases, or improve survival
Induction chemotherapy is not recommended as routine treatment for nasopharyngeal carcinoma
Clinical/Scientific Implications Compared to other head and neck cancers, the development of regional (nodal) and metastatic disease in nasopharyngeal cancer is much more common, and hence, presents a major dificulty in treatment. This study has a very long followup of up to 8 years, and therefore is valuable in assessing the impact of induction chemotherapy on the development of nodal and distant metastatic disease, and their impact on survival. This study confirms that induction chemotherapy followed by radiation therapy is not efficacious in the treatment of nasopharyngeal carcinoma. Concurrent chemoradiation, as outlined by Al-Sarraf, remains the standard of care in nasopharyngeal carcinoma
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