Clinical observation on advanced locoregioned nasopharyngeal carcinoma treated with radiotherapy plus neoadjuvant chemotherapy with maximum dose

Background and purpose:Nasopharyngeal carcinoma(NPC)is the most common cancer in southern China.Nearly 95% of NPC are poorly differentiated squamous cell carcinoma which are sensitive to radiotherapy and chemotherapy.The mainstay treatment option of NPC is radiotherapy,especially for early stage NPC.However,local recurrence with /or without distant metastasis is still the major concern after radiotherapy alone for locally advanced NPC.The consequent five year survival rate is as low as around 40%.In order to decrease the locoregional failure and reduce the distant metastasis rate,it is necessary to combine chemotherapy with radiotherapy.Our study is to explore the effect of treatment in patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy plus neoadjuvant chemotherapy.Methods:From May 1992 to August 1998,a total of 113 patients diagnosed as locally advanced NPC were eligible as neoadjuvant chemotherapy combined with radiation therapy(CT/RT)group,neoadjuvant chemotherapy regimens consisted of carboplatin(300 mg/m2,d1 iv drip),5-Fluorinracil(1 000 mg/m2,d1~d5 iv drip)interval 2-weeks after the chemotherapy;then enter into the second course.The total chemotherapy period was 3 courses.Another 113 patients according to the standard of Fuzhou staging to match cohort with the patients at same age,sex,histology and T,N,classification in CT/RT group were eligible in the radiation therapy(RT)alone group.Results:For short-term effects of chemotherapy,the overall response rates of primary tumor and lymph node were 53.9%(61/113)and 72.7%(56/77)respectively.For long-term effects:the 5-yeas overall survival rates in CT/RT group and RT group for stage Ⅲ disease were 76.3% and 47.3%,respectively(χ2=9.88507,P0.01),compared to 32.4% and 16.2% for stage Ⅳ disease(χ2=5.01345,P0.05).The 5-years disease free survival in CT/RT group and RT group for stage Ⅲ disease were 57% and 30.4%(χ2=8.648,P0.01),respectively compared to 29% and 16.2% for stage Ⅳ disease(χ2=8.6218,P0.01).The 5-years distant metastasis free rate in CT/RT group and RT group for stage Ⅲ disease were 64.4% and 37.8%,respectively,compared to 37.8% and 16.2%(χ2=9.50165,P0.01)for stage Ⅳ disease(χ2=4.3831,P0.05).There was significant difference between these two groups.Conclusions:Neoadjuvant chemotherapy could improve the overall survival rate,which is a good option for patients with locally advanced NPC.