Radiation therapy combined with (or without) cisplatin-based chemotherapy for patients with nasopharyngeal cancer: 15-years experience of a single institution in Korea.
OBJECTIVE
This retrospective study was carried out to evaluate the efficacy and toxicity of radiation therapy (RT) with/without cisplatin-based chemotherapy in nasopharyngeal cancer (NPC).


METHODS
One hundred forty six patients with NPC received curative RT and/or cisplatin-based chemotherapy. Thirty-nine patients were treated with induction chemotherapy (IC), including cisplatin and 5-fluorouracil followed by RT. Another 63 patients were treated with concurrent chemoradiotherapy (CCRT) using cisplatin, and 22 patients were treated with IC followed by CCRT. The remaining 22 patients were treated with RT alone.


RESULTS
One hundred four (80.0%) patients achieved complete response (CR), and 23 (17.7%) patients achieved partial response (PR). The patterns of failure were: locoregional recurrences in 21.2% and distant metastases in 17.1%. Five-year overall survival (OS) and progression free survival (PFS) were 50.7% and 45.0%, respectively. Multivariate Cox stepwise regression analysis revealed CR to chemoradiotherapy to be a powerful prognostic factor for OS. CR to chemoradiotherapy and completion of radiation according to the time schedule were favorable prognostic factors for PFS. A comparison of each treatment group (IC --> RT vs. CCRT vs. IC --> CCRT vs. RT alone) revealed no significant differences in the OS or PFS. However, subgroup analysis showed significant differences in both OS and DFS in favor of the combined chemoradiotherapy group compared with RT alone, for stage IV and T3-4 tumors. Grade 3-4 toxicities were more common in the combined chemoradiotherapy arm, particularly in the CCRT group.


CONCLUSIONS
This study was limited in that it was a retrospective study, much time was required to collect patients, and there were imbalances in the number of patients in each treatment group. Combined chemoradiotherapy remarkably prolonged the OS and PFS in subgroup patients with stage IV or T3-4 NPC.
Kim
Yeon-Sil
YS
Department of Radiation Oncology, The Catholic University of Korea, Seoul, Korea.
Kim
Bum-Soo
BS
Jung
So-Lyoung
SL
Lee
Yeon-Soo
YS
Kim
Min-Sik
MS
Sun
Dong-Il
DI
Yoo
Eun-Jung
EJ
Mun
Seong-Kwon
SK
Yoon
Sei-Chul
SC
Chung
Su-Mi
SM
Kim
Hoon-Kyo
HK
Jo
Seung-Ho
SH
Kang
Jin-Hyoung
JH
Int J Radiat Oncol Biol Phys. 1985 Aug;11(8):1455-9
3926733
Cancer. 1998 Dec 1;83(11):2270-83
9840526
J Clin Oncol. 1988 Sep;6(9):1401-10
3047335
J Clin Oncol. 1991 Sep;9(9):1675-81
1714951
J Clin Oncol. 2003 Feb 15;21(4):631-7
12586799
Int J Radiat Oncol Biol Phys. 1992;23(2):261-70
1587745
J Clin Oncol. 2002 Apr 15;20(8):2038-44
11956263
Cancer Res Treat. 2008 Jun;40(2):62-70
19688050
Int J Radiat Oncol Biol Phys. 1996 Sep 1;36(2):291-304
8892451
Int J Radiat Oncol Biol Phys. 1995 Jun 15;32(3):859-77
7790274
Int J Radiat Oncol Biol Phys. 1999 Oct 1;45(3):597-601
10524411
Int J Radiat Oncol Biol Phys. 1996 Dec 1;36(5):999-1004
8985019
Int J Radiat Oncol Biol Phys. 1994 Dec 1;30(5):1029-36
7961008
Int J Radiat Oncol Biol Phys. 1996 Jun 1;35(3):463-9
8655368
J Clin Oncol. 1998 Apr;16(4):1310-7
9552031
Int J Radiat Oncol Biol Phys. 1995 Oct 15;33(3):569-77
7558945
Am J Clin Oncol. 2002 Jun;25(3):219-23
12040275
Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):47-56
16377415
Oncology (Williston Park). 2000 Aug;14(8):1223-30; discussion 1232-7, 1239-42
10989829
J Clin Oncol. 2005 Oct 1;23(28):6966-75
16192584
Cancer. 1983 Jul 15;52(2):362-8
6190547
Int J Radiat Oncol Biol Phys. 1978 Mar-Apr;4(3-4):182-98
640889
J Clin Oncol. 2001 Mar 1;19(5):1350-7
11230478
J Clin Oncol. 2005 Sep 20;23(27):6730-8
16170180