Potential improvement of tumor control probability by induction chemotherapy for advanced nasopharyngeal carcinoma.
OBJECTIVE
To assess the reduction of tumor bulk and improvement of tumor control probability (TCP) by using induction chemotherapy for advanced nasopharyngeal carcinoma (NPC).


METHODS
From February to December 2005, 20 patients with Stage III-IVB NPC were treated with induction-concurrent chemotherapy and intensity-modulated radiotherapy with accelerated fractionation. Combination of cisplatin and 5-fluorouracil was used in the induction phase and single agent Cisplatin in the concurrent phase. All patients were irradiated at 2Gy per fraction, 6 daily fractions per week, to a total dose of 70Gy.


RESULTS
Nineteen (95%) patients completed all 3 cycles of induction chemotherapy and 90% had 2 cycles of concurrent chemotherapy. Induction chemotherapy achieved significant down-staging of T-category in 35% of patients (p=0.016) and reduction of gross tumor volume (GTV_P) from 55.6 to 22.9cc (mean 61.4%, p<0.001). Although the mean radiation dose did not show any substantial change, the volume within GTV_P that failed to reach 70Gy was reduced from 10.2% to 3.8% (p=0.017). The estimated local TCP increased from 0.83 to 0.89 (p=0.002).


CONCLUSIONS
Induction chemotherapy using cisplatin-5-fluorouracil could significantly reduce tumor bulk leading to potential improvement in tumor control.
Lee
Anne W M
AW
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong. awmlee@ha.org.hk
Lau
Kam Ying
KY
Hung
Wai Man
WM
Ng
Wai Tong
WT
Lee
Michael C H
MC
Choi
Cheuk Wai
CW
Chan
Connie C C
CC
Tung
Raymond
R
Cheng
Peter T C
PT
Yau
Tsz Kok
TK
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D020266:Radiotherapy, Conformal; D012074:Remission Induction; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D002945:Cisplatin; D005472:Fluorouracil