Background: For patients with locally advanced nasopharyngeal cancer, radiotherapy is the standard treatment but has poor outcome because of frequent loco-regional recurrences and distant metastases. We studied to determine whether the combined
induction chemotherapy and radical radiotherapy would improve the survival of such patients.
Methods: Patients in the trial had biopsy confirmed previously untreated, locally advanced stageⅢor IV nasopharyngeal cancer. They were assigned to receive 2~3 cycles of induction chemotherapy consisting of intravenous 5-fluorouracil(1.0
gm/㎡/day
for
5 day as a continuous infusion) and cisplatin(100 mg/㎡ on day 1) every 3 weeks followed by radical radiotherapy in six-weeks courses(6000~7500 cGy, 180~200 cGy/day, 5 days/week), or to radiotherapy(up to 7,500 cGy, 180~200 cGy/day, 5 days/week).
Results: Of the 58 enrolled patients, 54 patients were evaluable. Between the 23 combined therapy patients and 31 radiotherapy alone patients, the differences of age, sex, performance status, disease stage, and tumor differentiation were not
significant
statistically. Complete remissions were achievable in 69.6% of the patients in combined therapy group and 74.2% of those in radiotherapy alone group(p=0.323). The 4 year progression free survival was 53.2% in combined therapy group and 54.9% in
radiotherapy alone group(P=0.654); The 4 year overall survival was 58.8%, respectively(p=0.209). The side effects of combined therapy were comparable to those of radiotherapy, and there were no episodes of any life threatening toxicities.
Conclusion: Although the combined therapy with induction chemotherapy followed by radical radiotherapy did not improve the tumor controls and survivals than radiotherapy alone, but the side effects were comparable in both groups. To improve the
tumor
controls and survivals in patients with advanced nasopharyngeal cancer, different combined approaches such as concurrent or alternating chemo-radiotherapy is strongly recommended.
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