title: Induction chemotherapy with cisplatin, epirubicin, and paclitaxel (CEP), followed by concomitant radiotherapy and weekly paclitaxel for the management of locally advanced nasopharyngeal carcinoma. A Hellenic Cooperative Oncology Group phase II study.
abstract: BACKGROUND
  Clinical research on the treatment of nasopharyngeal cancer (NPC) has been focused primarily on the reduction of incidence of the development of distant metastases as well as the improvement of locoregional control.
  
  
  METHODS
  Untreated patients with stage IIB-IVB nonmetastatic NPC were treated with three cycles of induction chemotherapy (IC) consisting of epirubicin 75 mg/m(2) followed by paclitaxel 175 mg/m(2) as 3-h infusion on day 1 and cisplatin 75 mg/m(2) on day 2 every 3 weeks, followed by concomitant radiation therapy (70 Gy), and chemotherapy (CCRT) with weekly paclitaxel 60 mg/m(2).
  
  
  RESULTS
  From November 1999 until April 2003, 47 patients entered the study. Complete response rate post IC therapy was 15%, which was raised to 66% after the completion of CCRT. The most frequent side effect from IC was myelotoxicity (55%), whereas stomatitis and xerostomia were the most pronounced (grade 3, 4) toxicities during CCRT. The presence of Epstein-Barr virus (EBV) was detected either by in situ hybridization in tumor tissue sections or by polymerase chain reaction in the peripheral blood in 37 out of 46 patients tested (80%). All three histological types were associated with the presence of EBV. After a median follow-up of 23.5 months, median time to treatment failure was 17.9 months, whilst median survival has not been reached yet.
  
  
  CONCLUSIONS
  IC followed by CCRT is feasible and produces durable complete responses in the majority of patients with NPC. The case detection rate of EBV in this study appears to be similar to that reported from endemically infected regions.
authors.affiliation: AHEPA Hospital, Aristotle, University of Thessaloniki, Thessaloniki, Greece. fountzil@med.auth.gr
authors.forename: George
authors.initials: G
authors.lastname: Fountzilas
authors.forename: Christos
authors.initials: C
authors.lastname: Tolis
authors.forename: Anna
authors.initials: A
authors.lastname: Kalogera-Fountzila
authors.forename: Charisios
authors.initials: C
authors.lastname: Karanikiotis
authors.forename: Maria
authors.initials: M
authors.lastname: Bai
authors.forename: Despina
authors.initials: D
authors.lastname: Misailidou
authors.forename: Epaminodas
authors.initials: E
authors.lastname: Samantas
authors.forename: Eleni
authors.initials: E
authors.lastname: Athanassiou
authors.forename: Demetris
authors.initials: D
authors.lastname: Papamichael
authors.forename: Periklis
authors.initials: P
authors.lastname: Tsekeris
authors.forename: Nikos
authors.initials: N
authors.lastname: Catodritis
authors.forename: Angelos
authors.initials: A
authors.lastname: Nicolaou
authors.forename: George
authors.initials: G
authors.lastname: Plataniotis
authors.forename: Thomas
authors.initials: T
authors.lastname: Makatsoris
authors.forename: Pavlos
authors.initials: P
authors.lastname: Papakostas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zamboglou
authors.forename: John
authors.initials: J
authors.lastname: Daniilidis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use* / Q000633:toxicity*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D018579:Patient Selection; D010976:Platelet Count
chemical_list: D015251:Epirubicin; D017239:Paclitaxel; D002945:Cisplatin