title: Outcomes of induction chemotherapy followed by concurrent chemoradiation for nasopharyngeal carcinoma.
abstract: OBJECTIVE
  Current standard therapy for nasopharyngeal carcinoma (NPC) is concurrent chemoradiation based on randomized data. However, limited randomized data exist to support the addition of induction chemotherapy (ICT).
  
  
  METHODS
  58 Patients with NPC were treated from 1990 to 2010. All patients received platinum-based ICT. All 58 patients were treated with chemoradiation, 57 in a week-on/week-off (WOWO) fashion. Concurrent chemotherapy included hydroxyurea/5-fluorouracil for all patients. Median radiation dose was 70 Gy. No patient received adjuvant chemotherapy.
  
  
  RESULTS
  AJCC 2009 stage was II=13, III=21, IVa=13, and IVb=11. Median follow-up for surviving patients was 66 months. Response to ICT was complete response (CR) 17% and partial response (PR) 64%. The CR rate after chemoradiation was 96%. Five-year actuarial freedom from local failure (FFLF), freedom from distant failure (FFDF), cause-specific survival (CSS), and overall survival (OS) was 98%, 90%, 90%, and 76%, respectively. Analysis of pediatric patients (n=9) demonstrated 5-year actuarial FFLF, FFDF, CSS, and OS of 100%, 88%, 80%, and 80%, respectively.
  
  
  CONCLUSIONS
  ICT followed by concurrent chemoradiation demonstrates excellent FFLF, FFDF, CSS, and OS with tolerable toxicity. Induction chemotherapy followed by concurrent chemoradiation for patients with NPC should be explored further in a randomized setting.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA. dgolden@radonc.uchicago.edu
authors.forename: D W
authors.initials: DW
authors.lastname: Golden
authors.forename: S
authors.initials: S
authors.lastname: Rudra
authors.forename: M E
authors.initials: ME
authors.lastname: Witt
authors.forename: T
authors.initials: T
authors.lastname: Nwizu
authors.forename: E E W
authors.initials: EE
authors.lastname: Cohen
authors.forename: E
authors.initials: E
authors.lastname: Blair
authors.forename: K M
authors.initials: KM
authors.lastname: Stenson
authors.forename: E E
authors.initials: EE
authors.lastname: Vokes
authors.forename: D J
authors.initials: DJ
authors.lastname: Haraf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000532:radiotherapy / Q000556:secondary; D059248:Chemoradiotherapy / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D060828:Induction Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010984:Platinum / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010984:Platinum; D005472:Fluorouracil; D006918:Hydroxyurea