Radiotherapy with concurrent chemotherapy for treatment of advanced nasopharyngeal carcinoma

Abstract

Abstract: Objective To evaluate the effect of radiotherapy combined with concurrent chemotherapy for the treatment of advanced nasopharyngeal carcinoma. Methods From February 2001 to August 2003, 80 cases of nasopharyngeal carcinoma (stage Ⅲand Ⅳa) were randomized into two groups to receive radiotherapy with concurrent chemotherapy (Group A, n=40) consisted of leucovorin (CF, 100 mg/m², days 1-5), 5-fluorouracil (5-Fu, 500 mg/m², days 1-5), cisplatin (DDP, 60 mg/m², day 1) for one course followed by another 4 weeks later, or radiotherapy alone (Group B, n=40). In all cases, the radiotherapy followed the same protocol, with the nasopharyngeal (NP) total dose (DT) of 66-76 Gy given in 6.6-7.6 weeks, and cervical lymphnode (LN) DT of 60-72 Gy completed in 6.0-7.2 weeks. Results All patients completed the treatment course, and the complete response rates of the primary lesions and cervical nodes in A and B groups were 77.5% and 60.0% (P>0.05) and 92.5% vs 70.0% (P<0.05), respectively, which were 92.5% vs 72.5% (P<0.05) and 100% vs 85.0% (P<0.05), respectively, 3 months after treatment. No obvious toxicity was observed in the two groups except for vomiting and leukopenia. Conclusion Radiotherapy with concurrent chemotherapy can improve the elimination rate of advanced nasopharyngeal carcinoma, and can be completed in shorter treatment course in comparison with neoadjuvant chemotherapy before radiotherapy, eligible for clinical practice in the treatment of advanced nasopharyngeal carcinoma.

CLC Number:

FENG Zheng-fu, PAN Hui-lin, SONG Hui-sheng, LIU Zhuo-mei, HUANG Yan. Radiotherapy with concurrent chemotherapy for treatment of advanced nasopharyngeal carcinoma[J]. Journal of Southern Medical University, 2004, 24(06): 694-696.

References

[1] 严洁华,潘国英.鼻咽癌[A].见:谷铣之,殷蔚伯,刘泰福.肿瘤放射治疗学[M].第2版,北京:北京医科大学、中国协和医科大学联合出版社.1993.443-79.
[2] 李振.抗癌剂的临床试验疗效判定及统计学[A].见:李振.恶性肿瘤的化学治疗与免疫治疗[M].北京:人民卫生出版社,1990.57-72.
[3] Ensley JF,Youssef E,Kim H,et al.Locally advanced nasopharyngeal cancer[J].Curr Treat Options Oncol,2001,2(1):15-23.
[4] Civitkovic E,Eschwege F,Ranhal M,et al.Preliminary results of a randomized trial comparing neoadjuvant chemotherapy plus radiotherapy alone in stage IV (N3M0) undifferentiated asopharynge,al carcinoma [J].IhtJRadiat Oncol Biol Phys,1996,35(3):463-6.
[5] Cooper JS,Lee H,Torrey M,et al.Improved outcome secondary to concurrent chernoradiotherapy for advanced carcinoma of the nasopharynx:preliminary corroboration of the intergroup experience[J].IhtJRadiat Oncol Biol Phys,2000,47(4):861-6.
[6] 马骏,洪明晃,闵华庆,等.中晚期鼻咽癌新辅助化疗联合放疗前瞻性临床试验[J].癌症,1998,17(4):274-7.MaJ,Hong MH,Min HQ,et al.A randomized clinical trial of neoadjuvant chemotherapy combined with radiotherapy for advanced nasopharyngeal carcinoma[J].ChinJCancer,1998,17(4):274-7.
[7] 谢方云,卢泰祥,陈勇,等.PF方案联合放疗与常规放疗N2、N3期鼻咽癌的近期疗效比较[J].广州医药,2001,32(4):10-2.Xie FY,Lu TX,Chen Y,et al.Efficacy analysis of PF chemotherapy combined radiotherapy in patients with N2,N3 stage nasopharyngeal carcinoma (NPC)[J].Guangzhou Med,2001,32(4):10-2.
[8] 郭小毛,刘瑛,何少琴.放射联合顺铂治疗鼻咽癌的前瞻性临床研究[J].齐鲁肿瘤杂志(QiluJOnco1),1996,3(4):281-2.
[9] Lin JC,Jan JS,Hsu CY,et al.PhaseⅢ study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma:positive effect on overall and progression-free survival[J].Jclin Oncol,2003,21(4):631-7.
[10] Chi KH,Chang YC,Guo WY,et al.A phase Ⅲ study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients [J].IntJRadiat Oncol Biol Phys,2002,52(5):1238-44.
[11] Onat H,Basaran M,Esassolak M,et al.High-dose epirubicin and cisplatin in locally advanced undifferentiated nasopharyngeal carcinoma[J].Clin Oncol,2002,4(6):449-54.
[12] 黄国贤,赵充,韩非,等.中药防治鼻咽癌综合治疗中口咽急性毒性的临床研究[J].癌症,2003,22(10):1084-7.Huang GX,Zhao C,Han F,et al.Clinical study in prophylactic use of Chinese medicine to prevent chemoradiotherapy induced mucositis in nasopharyngeal carcinoma[J].ChinJCancer,2003,22(10):1084-7.
[13] Ma J,Mai HQ,Hong MH,et al.Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma[J].Jclin Oncol,2001,19(5):1350-7.
[14] Chua DT,ShamJS,Au GK,et al.Concomitant chemoirradiation for stage Ⅲ-IV nasopharyngeal carcinoma in Chinese patients:results of a matched cohort analysis[J].IntJRadiat Oncol Biol Phys,2002,53(2):334-43.
[15] Teo P,Ho JH,Choy D,et al.Adjunctive chemotherapy to radical radiation therapy in the treatment of advanced nasopharyngeal carcinoma[J].IntJRadiat Oncol Biol Phys,1987,13(5):679-85.
[16] Huncharek M,Kupelnick B.Combined chemoradiation versus radiation therapy alone in ocally advanced nasopharyngeal carcinoma:results of a meta-analysis of 1 528 patients from six randomized trials[J].AmJClin Oncol,2002,25(3):219-23.
[17] 顾仲义,魏青,黄克伟,等.PF方案化放治疗晚期鼻咽癌的远期疗效[J].中华肿瘤杂志,1997,19(5):392-4.Gu ZY,Wei Q,Huang KW.The long-term therapeutic results of chemotherapy combined with radiotherapy in advanced nasopharyngeal carcinoma[J].ChinJOncol,1997,19(5):392-4.
[18] Jen YM,Lin YS,Su WF,et al.Dose escalation using twice-daily radiotherapy for nasopharyngeal carcinoma:does heavier dosing result in a happier ending[J]? IntJRadiat Oncol Biol Phys,2002,54(1):14-22.
[19] Franchin G,Vaccher E,Talamini R,et al.Nasopharyngeal cancer WHO type Ⅱ -Ⅲ:monoinstitutional retrospective analysis with standard andaccelerated hyperfractionated radiation therapy [J].Oral Oncol,2002,38(2):137-44.
[20] Kim GE,LimJ,Park HC,et al.A feasibility study using three dimensional conformal boost technique in locally advanced carcinoma of the nasopharynx[J].Acta Oncol,2001,40(5):582-7.
[21] 吴德华,陈龙华.三维适形放射治疗局部复发鼻咽癌疗效观察[J].第一军医大学学报,2002,22(11):1028-9.Wu DH,Chen LH.Therapeutic effects of three-dimensional conformal radiation therapy for locally recurrent nasopharyngeal carcinoma [J].JFirst Mil Med Univ/Di YiJun Yi Da Xue Xue Bao,2002,22(11):1028-9..
[22] Hsiung CY,Yorke ED,Chui CS,et al.Intensity-modulated radiotherapy versus conventional three-dimensional conformal radiotherapy for boost or salvage treatment of nasopharyngeal carcinoma[J].IhtJRadiat Oncol Biol Phys,2002,53(3):638-47.
[23] Kam MK,Chau RM,SuenJ,et al.Intensity-modulated radiotherapy in nasopharyngeal carcinoma:dosimetric advantage over conventional plans and feasibility of dose escalation[J].IntJRadiat Oncol Biol Phys,2003,56(1):145-57.