Preliminary Experience on Treating Advanced Nasopharyngeal Carcinoma (NPC) Affecting/Abutting Neurological Structures with Induction Chemotherapy followed by Concurrent Chemo-Radiation with Accelerated Fractionation

Abstract

Background: To study the possibility of improving treatment tolerance and outcome for NPC with extensive infiltration affecting/ abutting neurological structures by induction chemotherapy followed by concurrent chemo-radiation with accelerated fractionation. Methods: During April 2001 to Feb 2003, 33 NPC patients with such ominous infiltration were treated with this strategy. Ninty-four percent of patients had UICC (5th edition) Stage IVA-B and 6% had Stage III disease. Thirty-two patients (97%) had undifferentiated carcinoma and only 1 patient had well differentiated squamous cell carcinoma. The chemotherapy plan included 3 cycles of Cisplatin (80 mg/m2 ) and Gemcitabine (1250 mg/m2 D1,8) for induction phase, and 2 cycles of Cisplatin (100 mg/m2 D1) for the concurrent phase. All patients were irradiated to a total dose of 70 Gy using 3-D conformal techniques and accelerated fractionation at 2 Gy per fraction, 6 daily fractions per week, throughout the whole course. Results: All patients completed the intended radiotherapy dose and the median overall treatment time was 41 days (range: 39–53). Grade ≥3 mucositis and skin reaction were observed in 82% and 21% patients, respectively. The mean weight loss during the whole course of treatment was 11% of the initial body weight. The chemotherapy toxicities and compliance are shown in table 1. With a median follow-up of 1.5 years (range: 0.6–2.3), the 2-year local failure-free, distant failure-free, progression-free and overall survival rates were 97%,76%, 73% and 76% respectively. Conclusions: The early treatment results achieved for this very poor prognostic group was very encouraging, but late toxicity has yet to be fully assessed and confirmation of therapeutic gain by prospective randomized trial is warranted.