title: Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study.
abstract: OBJECTIVE
  To study the efficacy of concurrent chemoradiotherapy (CRT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Oncology, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Dora L W
authors.initials: DL
authors.lastname: Kwong
authors.forename: Jonathan S T
authors.initials: JS
authors.lastname: Sham
authors.forename: Gordon K H
authors.initials: GK
authors.lastname: Au
authors.forename: Daniel T T
authors.initials: DT
authors.lastname: Chua
authors.forename: Philip W K
authors.initials: PW
authors.lastname: Kwong
authors.forename: Ashley C K
authors.initials: AC
authors.lastname: Cheng
authors.forename: P M
authors.initials: PM
authors.lastname: Wu
authors.forename: Martin W M
authors.initials: MW
authors.lastname: Law
authors.forename: Carol C H
authors.initials: CC
authors.lastname: Kwok
authors.forename: C C
authors.initials: CC
authors.lastname: Yau
authors.forename: K Y
authors.initials: KY
authors.lastname: Wan
authors.forename: Raymond T T
authors.initials: RT
authors.lastname: Chan
authors.forename: Damon D K
authors.initials: DD
authors.lastname: Choy
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D009362:Neoplasm Metastasis; D005641:Tegafur / Q000008:administration & dosage; D016896:Treatment Outcome; D014498:Uracil / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D005641:Tegafur; D014498:Uracil; D014750:Vincristine; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate