title: Docetaxel, cisplatin and 5-fluorouracil-based induction chemotherapy followed by intensity-modulated radiotherapy concurrent with cisplatin in locally advanced EBV-related nasopharyngeal cancer.
abstract: BACKGROUND
  This monocentric study evaluates the activity and tolerability of docetaxel (Taxotere), cisplatin and 5-fluorouracil (5-FU) (TPF) induction chemotherapy followed by intensity-modulated radiotherapy (IMRT) concurrent with high-dose cisplatin in Epstein-Barr virus -related locally advanced undifferentiated nasopharyngeal cancer.
  
  
  METHODS
  We retrospectively reviewed the records of patients who received induction docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) on day 1, and 5-FU 750 mg/m(2)/day (96-h continuous infusion). Following induction, patients received full doses of IMRT concurrently with cisplatin 100 mg/m(2) every 21 days for three cycles.
  
  
  RESULTS
  Thirty patients received three TPF cycles (median). Induction was well tolerated; the main toxicity was neutropenia (33%, grade 3-4). During chemoradiotherapy, neutropenia (40%) and mucositis (43%) were the most frequent grade 3-4 adverse events. Mean dose of IMRT was 68.8 Gy. Worst late toxicity was xerostomia. Complete response rate was 93%. At 35 months, two patients had locoregional recurrence, three had distant metastases, and one had both. Three-year progression-free survival and overall survival were 79% [95% confidence interval (CI) 64% to 94%] and 87% (95% CI 74%- to 100%), respectively.
  
  
  CONCLUSIONS
  In this high-stage nonendemic cancer population, TPF followed by high-dose cisplatin IMRT was promising; this treatment approach deserves evaluation in randomized trials.
authors.affiliation: Department of Medical Oncology.
authors.forename: P
authors.initials: P
authors.lastname: Bossi
authors.affiliation: Department of Radiotherapy.
authors.forename: E
authors.initials: E
authors.lastname: Orlandi
authors.affiliation: Department of Medical Oncology.
authors.forename: C
authors.initials: C
authors.lastname: Bergamini
authors.affiliation: Department of Medical Oncology.
authors.forename: L D
authors.initials: LD
authors.lastname: Locati
authors.affiliation: Department of Medical Oncology.
authors.forename: R
authors.initials: R
authors.lastname: Granata
authors.affiliation: Department of Medical Oncology.
authors.forename: A
authors.initials: A
authors.lastname: Mirabile
authors.affiliation: Department of Medical Oncology.
authors.forename: D
authors.initials: D
authors.lastname: Parolini
authors.affiliation: Department of Radiotherapy.
authors.forename: M
authors.initials: M
authors.lastname: Franceschini
authors.affiliation: Department of Radiotherapy.
authors.forename: C
authors.initials: C
authors.lastname: Fallai
authors.affiliation: Department of Radiotherapy.
authors.forename: P
authors.initials: P
authors.lastname: Olmi
authors.affiliation: Pathologic Unit.
authors.forename: P
authors.initials: P
authors.lastname: Quattrone
authors.affiliation: Department of Radiology.
authors.forename: P
authors.initials: P
authors.lastname: Potepan
authors.affiliation: Department of Molecular Biology.
authors.forename: A
authors.initials: A
authors.lastname: Gloghini
authors.affiliation: Statistics Unit.
authors.forename: R
authors.initials: R
authors.lastname: Miceli
authors.affiliation: Statistics Unit.
authors.forename: F
authors.initials: F
authors.lastname: Mattana
authors.affiliation: Department of Otorhinolaryngoiatry, Tumor National Institute, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scaramellini
authors.affiliation: Department of Medical Oncology. Electronic address: lisa.licitra@istitutotumori.mi.it.
authors.forename: L
authors.initials: L
authors.lastname: Licitra
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D000077143:Docetaxel; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D060828:Induction Chemotherapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy* / Q000821:virology*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil