A Prospective Randomized Study of Sequential Therapy of Chemotherapy and Radiotherapy in Advanced Nasopharyngeal Carcinoma

Objective A prospective randomized trial was conducted to compare chemoradiotherapy against radiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma. Methods Between April 2000 and April 2001,84 patients with histologically proven advanced nasopharyngeal carcinoma were radiotherapy alone(RT group) and chemotherapy plus radiotherapy(combination group).There was fourty-two patients in each group.All patients received radical radiotherapy to the nasopharynx and neck.Planned RT was 2 Gy/day fraction to 70 Gy to the primary tumor,with 50 and 70 Gy to the node negative and to palpable nodes,respectively.The combination group received two cycles of induction chemotherapy with cisplatin and 5-fluorouracil before radical radiotherapy, and four cycles of postradiotherapy chemotherapy.Results The overall response rate to neoadjuvant chemotherapy was 85.7%.The overall complete response rate to chemoradiotherapy was 90.5%,and to radiotherapy alone,71.4%.At a follow-up of 5 years,23.8% of patients in combination group and 47.6% in RT group developed distant metastases.Time of distant metastases was 20.4 months in combination group and 7.9 months in combination group.The 5-year disease-free survival rates were higher in combination group.This finding was statistically significant(all P0.05).The 5-year overall survival rates were not significantly different between the two arms(P0.05).There were not serious toxicities in the two arms.Conclusion Chemotherapy with DDP and 5-FU in advanced nasopharyngeal carcinoma can improve overall response rate and disease-free survival rates.The overall survival was not significant benefit.This regimen was well tolerated.Induction chemotherapy followed by alternating chemo-radiotherapy is feasible and worth to be recommended in clinic.