Open AccessNew Approaches for Locally Advanced Nasopharyngeal Carcinoma
Author(s) -
Pecorari Giancarlo,
Raimondo Luca,
Garzaro Massimiliano,
Airoldi Mario,
Riva Giuseppe,
Cerutti Marta,
Giordano Carlo
Publication year - 2012
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599812451438a122
Subject(s) - medicine , mucositis , concomitant , epirubicin , nasopharyngeal carcinoma , gastroenterology , carboplatin , neutropenia , chemotherapy , toxicity , anemia , population , cisplatin , surgery , radiation therapy , cyclophosphamide , environmental health
Objective To evaluate 2 different schemes of neoadjuvant chemotherapy (NACT) followed by 2 different concomitant chemoradiotherapy (CHRT) schedules in loco‐regionally advanced nasopharyngeal carcinoma (A‐NPC) observed in a nonendemic population. Method Seventy homogeneous patients affected by A‐NPC were enrolled in this retrospective study. Forty patients (group A) underwent 3 cycles of NACT with cisplatin+epirubicin followed by cisplatin+70 Gy RT; and 30 patients (group B) received 3 cycles of NACT with carboplatin+taxol followed by weekly carboplatin+taxol for 7 weeks+concomitant 70Gy RT. Results After NACT, results in group A and B were: CRs 30% vs 33%, PRs 60% vs 60%, NC 10% vs 6.6%; after CHRT: CRs 75% vs 87%, PRs 25% vs 13%. After median follow‐up of 54 months (A) and 49 months (B), 3‐5 years progression‐free survival were 75% vs 80% and 65% vs 75%, respectively, and overall survival was 84% vs 85% and 77% vs 80%, respectively; 5 years locoregional control was 70% vs 90%, and 5 years distant metastases–free survival was 75% vs 85%. NACT toxicity was as follows: G3‐4 neutropenia 40% vs 83%, G3 thrombocytopenia 12% vs 13%, G3 anemia 0% vs 10% and G3 mucositis 2.5% vs 6.6%; CHRT toxicity was as follows: G3‐G4 neutropenia 20% vs 63%; G3 anemia 2.5% vs 17%, G3‐G4 mucositis 32.5% vs 69%; skin toxicity 25% vs 23% and G3 neurotoxicity 5% vs 10%. Conclusion NACT followed by CHRT represents a feasible, highly effective treatment for patients with A‐NPC, with excellent locoregional disease control and overall survival and with low incidence of distant metastases. Double drug CHRT in group B is characterized by higher incidence of acute toxicities without significant impact on major clinical outcomes.