Control of regional metastasis after induction chemotherapy and radiotherapy for nasopharyngeal carcinoma

Abstract

Background: To study the impact of adding induction chemotherapy to radiotherapy on the long-term control of regional metastasis and survival in patients with nasopharyngeal carcinoma (NPC).

Methods: Between February 1988 and August 1993, 240 NPC patients with Ho's T3 stage, N2-3 stage, or nodal size >/=3 cm were recruited onto two randomized trials comparing induction chemotherapy followed by radiotherapy (CT + RT) and radiotherapy alone (RT) using a similar treatment protocol. Of these, 210 patients (105 in each treatment arm) had cervical nodal metastasis and were included in the analysis. Patients in the CT + RT arm received two to three cycles of cisplatin, 60 mg/m(2) day 1, + epirubicin, 110 mg/m(2) day 1, followed by radiotherapy. Radiotherapy technique and dose were similar in both arms. The median follow-up time was 71 months (range, 5-152 months).

Results: The overall response rate of nodal disease to chemotherapy was 86%, and the complete response (CR) rate was 44%. At the end of radiotherapy, 92% of patients in the CT + RT arm and 86% in the RT arm achieved CR in the neck (p =.12). The 5-year nodal relapse-free survival rates in the CT + RT and RT arm were 83% and 75%, respectively (p =.13). Most neck failures (81%) occurred during the first 36 months of follow-up. Radical neck dissection successfully salvaged 41% of neck failures in the CT + RT arm and 46% in the RT arm. The 5-year distant metastases-free survival rates were 70% in the CT + RT arm and 68% in the RT arm (p =.56), and the corresponding 5-year disease-specific survival rates were 66% and 68%, respectively (p =.55). In subgroup analysis, no significant differences in regional control and survival could be found in patients with Ho's N2-3 stage, AJCC N2-3 stage, or nodal size >6 cm.

Conclusions: Induction chemotherapy does not seem to improve the regional control and survival in NPC patients with regional metastasis compared with radiotherapy alone and is not recommended as a routine treatment outside the context of a clinical trial.