Concurrent and Adjuvant Chemotherapy for Nasopharyngeal Carcinoma: A Factorial Study

• Published in: Journal of clinical oncology Vol. 22; no. 13; pp. 2643 - 2653
• Main Authors: KWONG, Dora L. W, SHAM, Jonathan S. T, WAN, K. Y, CHAN, Raymond T. T, CHOY, Damon D. K, AU, Gordon K. H, CHUA, Daniel T. T, KWONG, Philip W. K, CHENG, Ashley C. K, WU, P. M, LAW, Martin W. M, KWOK, Carol C. H, YAU, C. C
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01-07-2004; Lippincott Williams & Wilkins
• Subjects: Administration, Oral; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bleomycin - administration & dosage; Carcinoma - drug therapy; Carcinoma - pathology; Carcinoma - radiotherapy; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Combined Modality Therapy; Disease-Free Survival; Female; Fluorouracil - administration & dosage; Humans; Infusions, Intravenous; Male; Medical sciences; Methotrexate - administration & dosage; Middle Aged; Nasopharyngeal Neoplasms - drug therapy; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - radiotherapy; Neoplasm Metastasis; Tegafur - administration & dosage; Treatment Outcome; Tumors; Uracil - administration & dosage; Vincristine - administration & dosage; Antineoplastic agent; Chemotherapy; Cancerology; Carcinoma; Treatment; Concurrent; Nasopharyngeal; Adjuvant; Nasopharynx; Malignant tumor
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2004.05.173

To study the efficacy of concurrent chemoradiotherapy (CRT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC).
Patients with Ho's stage T3 or N2/N3 NPC or neck node > or = 4 cm were eligible. Patients were randomly assigned to have radiotherapy (RT) or CRT with uracil and tegafur and to have AC or no AC after RT/CRT. AC comprised alternating cisplatin, fluorouracil, vincristine, bleomycin, and methotrexate for six cycles. There were four treatment groups: A, RT; B, CRT; C, RT and AC; D, CRT and AC. For CRT versus RT, groups B and D were compared with groups A and C. For AC versus no AC, groups C and D were compared with groups A and B.
Three-year failure-free survival (FFS) and overall survival (OS) for CRT versus RT were 69.3% versus 57.8% and 86.5% versus 76.8%, respectively (P =.14 and.06; n = 110 v 109). Distant metastases rate (DMR) was significantly reduced with CRT (14.8% v 29.4%; P =.026). Locoregional failure rates (LRFR) were similar (20% v 27.6%; P =.39). Three-year FFS and OS for AC versus no AC were 62.5% versus 65% and 80.4% versus 83.1%, respectively (P =.83 and.69; n = 111 v 108). DMR and LRFR were not reduced with AC (P =.34 and.15, respectively). Cox model showed CRT to be a favorable prognostic factor for OS (hazard ratio, 0.42; P =.009).
An improvement in OS with CRT was observed but did not achieve statistical significance. The improvement seemed to be associated with a significant reduction in DMR. AC did not improve outcome.