Correlation of outcome with early metabolic response on FDG-PET in treatment of locally advanced nasopharyngeal carcinoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17555-e17555 ◽  
Author(s):  
Dora Lai Wan Kwong ◽  
Victor HF Lee ◽  
Pek lan Khong
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Metabolic Response ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Distant Metastases ◽  
Favourable Outcome ◽  
Free Survival ◽  
Pet Scans ◽  
Early Metabolic Response

e17555 Background: Skull base changes often persist on CT and MRI after treatment in locally advanced nasopharyngeal carcinoma (NPC) and cannot be differentiated from active tumor. We prospectively evaluated the metabolic response of T3/T4 NPC during treatment with PET scans. Early metabolic response was correlated with outcome after treatment. Methods: 50 patients with T3/T4, N0-3, M0 NPC were recruited. All patients had 3 cycles of induction chemotherapy (IC, physician’s choice of regime) before concurrent chemoradiation (CRT) with cisplatin 100mg/sqm for 3 cycles. PET scans were performed before and after IC and at 30Gy of CRT. For primary tumor that showed complete metabolic response (mCR, defined as SUV max in tumor ≤1.25x liver background activity) on reassessment PET, the dose to tumor stopped at 70Gy. For those who did not achieve mCR, a boost dose was given to the residual tumor to total 76Gy. Results: On post-IC PET scan, 2 patients with extensive intracranial disease showed no response with static and progressive disease respectively and did not proceed to CRT. 48 patients showed regression of tumor and decreased metabolic activity on post-IC PET, 16 of whom achieved mCR. One patient with mCR after IC refused CRT. 47 patients proceeded to CRT. 44 patients had reassessment PET at around 30Gy and 25 patients had mCR during CRT. 47 patients who completed CRT were included in survival analysis. Median follow up after completion of CRT was 28 months. Among the 15 cases who achieved mCR after IC, all patients were disease free without relapse at time of analysis. Among the 32 patients who did not achieve mCR after IC, there was 1 persistent loco-regional disease, 1 local and 1 regional relapse and 6 developed distant metastases. The 3 year NP control, regional control, distant metastases free, progression free survival and overall survival were 89.4%, 96.9%, 79.5%, 49.2% and 81% respectively compared with 100% corresponding survival rates among patients who achieved mCR after IC. The difference in progression-free survival was statistically significant (p = 0.045) Conclusions: Early mCR was observed in 32% patient after IC and 56.8% of patients during CRT. mCR after IC predicts for very favourable outcome.

Role of modern neoadjuvant chemoradiotherapy in locally advanced thymic epithelial neoplasms

2020 ◽  
pp. 030089162096798
Author(s):  
Yirui Zhai ◽  
Dazhi Chen ◽  
Yushun Gao ◽  
Zhouguang Hui ◽  
Liyan Xue ◽  
...  
Keyword(s):  
Adverse Events ◽  
Thymic Carcinoma ◽  
Locally Advanced ◽  
Survival Rates ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Progression Free Survival ◽  
Stage Iii ◽  
Free Survival ◽  
Epithelial Neoplasms

Purpose: To improve resectability in patients with stage III–IVA thymic epithelial neoplasms, neoadjuvant chemotherapy and radiotherapy are considered. This retrospective study aimed to investigate the efficacy and safety of neoadjuvant therapies using modern techniques in thymic epithelial neoplasms. Methods: We included 32 patients with Masaoka stage III–IV disease treated at our institution from January 2010 to December 2017. Data regarding clinicopathologic characteristics, treatment protocols, toxicities, and survival were collected. Response was evaluated according to the Response Evaluation Criteria in Solid Tumours 1.1. Survival was assessed using the Kaplan-Meier method. Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Results: Neoadjuvant radiotherapy alone, chemotherapy alone, sequence chemoradiotherapy, and concurrent chemoradiotherapy were administered to 10 (31.3%), 9 (28.1%), 3 (9.4%), and 10 (31.3%) patients, respectively. Twenty-nine patients (90.6%) underwent R0 resection. The median follow-up time was 38.0 months (3.3–109.5 months). After neoadjuvant therapy, 18 patients (56.3%) achieved partial response and 14 (43.8%) had stable disease. Pathologic complete response was achieved in 6 patients (18.8%), all of whom had thymic carcinoma. The 5-year overall and progression-free survival rates were 90.9% and 67.5%, respectively. For patients with thymic carcinoma, the 5-year overall and progression-free survival rates were 80.0% and 66.2%, respectively. Grade 3 toxicities were observed in only 1 patient (leukopenia). Conclusions: For patients with primary unresectable thymic neoplasms, neoadjuvant chemoradiotherapy is an efficient and safe choice, with favorable response and survival and moderate toxicities. Patients with thymic carcinoma might benefit more from neoadjuvant therapies.

Safety and efficacy of docetaxel combined with cisplatin as induction chemotherapy followed by cisplatin concurrent chemoradiotherapy plus gemcitabine as adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma: A prospective and multicenter phase II trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6064-6064
Author(s):  
Zhi Hui Wang ◽  
Peijian Peng ◽  
Siyang Wang ◽  
Yumeng Liu ◽  
Zhong Lin
Keyword(s):  
Radiation Therapy ◽  
Adjuvant Chemotherapy ◽  
Induction Chemotherapy ◽  
Treatment Strategy ◽  
Objective Response ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Free Survival ◽  
Safety And Efficacy

6064 Background: Radiation therapy is the only curative treatment modality for nonmetastatic nasopharyngeal cancer (NPC). Concurrent chemoradiation (CCRT) is the standard treatment strategy for NPC in locally advanced stages. However, the results after such treatment are suboptimal. Clearly, novel treatment strategies are needed to further improve patients’ survival rates. This trial aimed to determine the safety and efficacy of a new treatment strategy. Methods: Patients with stage III – IVa-b NPC received TP (docetaxel 75 mg/m2, cisplatin 75 mg/m2 every 3 weeks for 2-3 cycles) followed by cisplatin chemotherapy concurrently with either 3-dimentional conformal radiation therapy or intensity-modulated radiation therapy plus gemcitabine (1000mg/m2 every 2 weeks for 2 cycles) as adjuvant chemotherapy. Objective response rates and acute toxicity were assessed based on RECIST (1.1) and CTCAE v.4.0, respectively. Kaplan-Meier analysis was used to calculate survival rates. This trial is registered with the Chinese Clinical Trials Registry, number ChiCTR-OIC-17011464. Results: From July 2010 to July 2017, 20 eligible patients with nonmetastatic stage III-IVb NPC were enrolled. The objective response rates were 90% (3 complete responses [CRs] and 15 partial responses [PRs]) after two or three cycles of induction chemotherapy (ICT) and 100% (17 CRs and three PRs) after CCRT plus gemcitabine adjuvant chemotherapy, respectively. With a median follow-up time of 41 months, the 3-year overall survival rates were 90% (18/20,95% confidence interval [CI], 76.9%-100%).The 3-year progression-free survival, distant metastasis-free survival, and local progression-free survival rates were 80% (16/20,95% CI, 62.5%-97.5%), 85% (17/20,95% CI, 69.4%-100%),95% (19/20,95% CI, 85,4%-100%), respectively. The most frequent grade 3–4 toxicities were neutropenia (3/20,15%) and nausea (2/20,10%) after ICT and thrombocytopenia (6/20,30%) and leukopenia (6/20,30%) after CCRT plus gemcitabine adjuvant chemotherapy. Conclusions: Neoadjuvant TP followed by concurrent chemoradiation plus gemcitabine as adjuvant chemotherapy was well tolerated and produced promising outcomes in patients with LA-NPC in this hypothesis-generating study. The authors concluded that randomized controlled trials are warranted to definitively confirm this aggressive and potentially efficacious strategy. Clinical trial information: ChiCTR-OIC-17011464.

A randomized phase III multicenter trial of neoadjuvant docetaxel plus cisplatin and 5-fluorouracil (TPF) versus neoadjuvant PF in patients with locally advanced unresectable squamous cell carcinoma of the head and neck (SCCHN). Final analysis of EORTC 24971

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5516-5516 ◽  
Author(s):  
E. Remenar ◽  
C. Van Herpen ◽  
J. Germa Lluch ◽  
S. Stewart ◽  
T. Gorlia ◽  
...  
Keyword(s):  
Response Rate ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Final Analysis ◽  
Distant Metastases ◽  
Phase Iii ◽  
Treatment Center ◽  
Severe Thrombocytopenia ◽  
Phase Ii Studies

5516 Background: So far, the Wayne State regimen combining 100 mg/m2 cisplatin on day 1 and 1000 mg/m2/d continuous infusion 5-fluorouracil over 5 days (PF), is the gold standard in advanced SCCHN. Improvement of PF induction chemotherapy by adding a taxane has been suggested from phase II studies and 2 randomized phase III trials. We now report the final analysis of EORTC 24971. Methods: Eligible were patients (pts) with unresectable stage III/IV SCCHN (no distant metastases), 18 to 70 yrs of age, PS≤1, and adequate hematologic, renal and hepatic function. Pts were stratified by primary disease site (oral cavity, oropharynx, hypopharynx, larynx) and treatment center and randomized to PF (as above) or TPF (T 75 mg/m2/1h, P 75 mg/m2/1h, both d1, F 750 mg/m2/d, d1–5) q 3 wks, for 4 cycles unless progression (PD) or unacceptable toxicity, or refusal. Thereafter (interval 4–7 wks), all pts not in PD received radiotherapy (RT: conventional [66–70 Gy], accelerated [max. 70 Gy] / hyperfractionated [max. 74 Gy]). Surgery was allowed before RT (neck) or 3 months after RT (primary, neck). Primary endpoint was progression-free survival (PFS), and 348 pts and 260 events were needed to detect a 50% increase in median PFS (10 vs 15 mo) with 85% power. Results: Between April 1999 and March 2002, 358 pts were accrued (181 PF, 177 TPF). At a median follow-up (FUP) of 32 mo, PFS was significantly improved with TPF (HR 0.72, p = 0.0071; median 8.2 vs 11.0 mo). A 51 mo median FUP showed an overall survival (OS) benefit with TPF (HR 0.71, p = 0.0052; median 14.2 vs 18.6 mo). Estimated 3-yr survival rates are 23.9% (95% CI: 17.9%;30.5%) for PF and 36.5% (29.3%;43.6%) for TPF. Response rate also favored TPF (53.6% vs 67.8%, p = 0.006). There was more severe (G3+4) leucopenia (41.6% vs 22.9%) and neutropenia (76.9% vs 52.5%) with TPF, and more severe thrombocytopenia with PF (17.9% vs 5.2%). Severe alopecia occured more with TPF (55.5% vs 11.7%); hearing loss (2.8% vs 0%) and toxic death (7.8% vs 3.7%) more with PF. Conclusions: TPF (→ RT) is superior to PF (→ RT) for PFS, OS (including long-term), response rate, and is better tolerated. [Table: see text]

Induction chemotherapy with cisplatin and epirubicin followed by radiotherapy and concurrent cisplatin in locally advanced nasopharyngeal carcinoma observed in a nonendemic population

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17040-e17040
Author(s):  
M. Airoldi ◽  
M. Garzaro ◽  
A. Gabriele ◽  
L. Raimondo
Keyword(s):  
Overall Survival ◽  
Nasopharyngeal Carcinoma ◽  
Induction Chemotherapy ◽  
Objective Response ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Efficient Treatment ◽  
Free Survival ◽  
Therapy Choice

e17040 Background: Chemoradiotherapy (CRT) represents the main therapy choice in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). Aim of this study was the clinical evaluation of neoadjuvant chemotherapy (NACT) followed by CRT in a non endemic population affected by advanced NPC. Methods: Patients with locoregionally advanced NPC were treated with three cycles of induction chemotherapy (CHT) with cisplatin (100 mg/m2) plus epirubicin (90 mg/m2), followed by cisplatin (100 mg/m2) and concomitant radiotherapy (70 Gy). Results: In 40 patients treated with such protocol, after the completion of induction CHT and CRT we observed the objective response rates of 90% and 100% respectively. Treatment tolerability and toxicity were easily controllable. With a median follow-up time of 54.5 months 3- and 5-years disease-free survival was 75% and 65.4% and 3- and 5-years overall survival was 84% and 77.5%. 3- and 5-years loco-regional control was 82.4% and 70.3%, and 5-years distant metastases-free survival was 75%. Conclusions: NACT with cisplatin and epirubicin followed by concomitant CRT represents a feasible, efficient treatment for patients with advanced NPC. This regimen ensures an excellent locoregional disease control and overall survival with a low incidence of distant metastases. No significant financial relationships to disclose.

Phase III Study of Concurrent Chemoradiotherapy Versus Radiotherapy Alone for Advanced Nasopharyngeal Carcinoma: Positive Effect on Overall and Progression-Free Survival

2003 ◽  
Vol 21 (4) ◽  
pp. 631-637 ◽  
Author(s):  
Jin-Ching Lin ◽  
Jian-Sheng Jan ◽  
Chen-Yi Hsu ◽  
Wen-Miin Liang ◽  
Rong-San Jiang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Concurrent Chemoradiotherapy ◽  
Combined Treatment ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Concurrent Chemotherapy ◽  
Phase Iii ◽  
Rank Test ◽  
Free Survival

Purpose: Nasopharyngeal carcinoma (NPC) is a radiosensitive and chemosensitive tumor. This randomized phase III trial compared concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in patients with advanced NPC. Patients and Methods: From December 1993 to April 1999, 284 patients with 1992 American Joint Committee on Cancer stage III to IV (M0) NPC were randomly allocated into two arms. Similar dosage and fractionation of RT was administered in both arms. The investigational arm received two cycles of concurrent chemotherapy with cisplatin 20 mg/m2/d plus fluorouracil 400 mg/m2/d by 96-hour continuous infusion during the weeks 1 and 5 of RT. Survival analysis was estimated by the Kaplan-Meier method and compared by the log-rank test. Results: Baseline patient characteristics were comparable in both arms. After a median follow-up of 65 months, 26.2% (37 of 141) and 46.2% (66 of 143) of patients developed tumor relapse in the CCRT and RT-alone groups, respectively. The 5-year overall survival rates were 72.3% for the CCRT arm and 54.2% for the RT-only arm (P = .0022). The 5-year progression-free survival rates were 71.6% for the CCRT group compared with 53.0% for the RT-only group (P = .0012). Although significantly more toxicity was noted in the CCRT arm, including leukopenia and emesis, compliance with the combined treatment was good. The second cycle of concurrent chemotherapy was refused by nine patients and was delayed for ≥ 1 week for another nine patients. There were no treatment-related deaths in either arm. Conclusion: We conclude that CCRT is superior to RT alone for patients with advanced NPC in endemic areas.

scholarly journals T4-Locally Advanced Nasopharyngeal Carcinoma: Prognostic Influence of Cranial Nerve Involvement in Different Radiotherapy Techniques

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Hsin-I Huang ◽  
Kee-Tak Chan ◽  
Chih-Hung Shu ◽  
Ching-Yin Ho
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Cranial Nerve ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Cranial Nerve Involvement ◽  
Free Survival ◽  
Nerve Involvement ◽  
Disease Free ◽  
3D Crt

Background. Cranial nerve involvement at disease presentation of nasopharyngeal carcinoma was not uncommon. We investigated the prognosis of patients with T4-locally advanced NPC, with or without cranial nerve involvement, and compared the outcome of patients treated using different radiotherapy techniques.Methods. In this retrospective study, 83 T4-locally advanced NPC patients were diagnosed according to the seventh edition of the American Joint Committee on Cancer staging system. All patients were treated using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT). The survival rate was analyzed using the Kaplan-Meier method.Results. The 5-year overall, locoregional-free, and disease-free survival rates of patients treated using IMRT were 88.9%, 75.2%, and 69.2%, respectively. The outcome in these patients was significantly better than that in patients treated using 3D-CRT, with survival rates of 58.2%, 54.4%, and 47.2%, respectively. There was no significant difference in the 5-year overall, locoregional-free, and disease-free survival rates of the patients with (64.2%, 60.5%, and 53.5%, resp.) and without (76.9%, 63.6%, and 57.6%, resp.) cranial nerve involvement.Conclusion. Locally advanced NPC patients treated using IMRT had significantly better outcomes than patients treated using 3D-CRT. Our results showed that the outcome of T4 NPC patients with or without cranial nerve involvement was not different.

Multiinstitutional phase II trial of paclitaxel, carboplatin, and concurrent radiation therapy for locally advanced non-small-cell lung cancer.

1998 ◽  
Vol 16 (10) ◽  
pp. 3316-3322 ◽  
Author(s):  
H Choy ◽  
W Akerley ◽  
H Safran ◽  
S Graziano ◽  
C Chung ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Phase Ii ◽  
Advanced Nsclc ◽  
Response Rate ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Free Survival ◽  
Locally Advanced Nsclc

PURPOSE Combined modality therapy for non-small-cell lung cancer (NSCLC) has produced promising results. A multiinstitutional phase II clinical trial was conducted to evaluate the activity and toxicity of paclitaxel, carboplatin, and concurrent radiation therapy on patients with locally advanced NSCLC. PATIENTS AND METHODS Forty previously untreated patients with inoperable locally advanced NSCLC entered onto a phase II study from March 1995 to December 1996. On an outpatient basis for 7 weeks, patients received paclitaxel 50 mg/m2 weekly over 1 hour; carboplatin at (area under the curve) AUC 2 weekly; and radiation therapy of 66 Gy in 33 fractions. After chemoradiation therapy, patients received an additional two cycles of paclitaxel 200 mg/m2 over 3 hours and carboplatin at AUC 6 every 3 weeks. RESULTS Thirty-nine patients were eligible for the study. The survival rates at 12 months were 56.3%, and at 24 months, 38.3%, with a median overall survival of 20.5 months. The progression-free survival rates at 12 months were 43.6%, and at 24 months, 34.7%, with a median progression-free survival of 9.0 months. Two patients did not receive more than 2 weeks of concurrent chemoradiotherapy and were not assessable for toxicity and response. The overall response rate (partial plus complete response) of 37 assessable patients was 75.7%. The major toxicity was esophagitis. Seventeen patients (46%) developed grade 3 or 4 esophagitis. However, only two patients developed late esophageal toxicity with stricture at 3 and 6 months posttreatment. CONCLUSION Combined modality therapy with paclitaxel, carboplatin, and radiation is a promising treatment for locally advanced NSCLC that has a high response rate and acceptable toxicity and survival rates. A randomized trial will be necessary to fully evaluate the usefulness of these findings.

Long-Term Survival Results of a Randomized Trial Comparing Gemcitabine Plus Cisplatin, With Methotrexate, Vinblastine, Doxorubicin, Plus Cisplatin in Patients With Bladder Cancer

2005 ◽  
Vol 23 (21) ◽  
pp. 4602-4608 ◽  
Author(s):  
Hans von der Maase ◽  
Lisa Sengelov ◽  
James T. Roberts ◽  
Sergio Ricci ◽  
Luigi Dogliotti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Visceral Metastases ◽  
Overall Survival Rates

Purpose To compare long-term survival in patients with locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium treated with gemcitabine/cisplatin (GC) or methotrexate/vinblastine/doxorubicin/cisplatin (MVAC). Patients and Methods Efficacy data from a large randomized phase III study of GC versus MVAC were updated. Time-to-event analyses were performed on the observed distributions of overall and progression-free survival. Results A total of 405 patients were randomly assigned: 203 to the GC arm and 202 to the MVAC arm. At the time of analysis, 347 patients had died (GC arm, 176 patients; MVAC arm, 171 patients). Overall survival was similar in both arms (hazard ratio [HR], 1.09; 95% CI, 0.88 to 1.34; P = .66) with a median survival of 14.0 months for GC and 15.2 months for MVAC. The 5-year overall survival rates were 13.0% and 15.3%, respectively (P = .53). The median progression-free survival was 7.7 months for GC and 8.3 months for MVAC, with an HR of 1.09. The 5-year progression-free survival rates were 9.8% and 11.3%, respectively (P = .63). Significant prognostic factors favoring overall survival included performance score (> 70), TNM staging (M0 v M1), low/normal alkaline phosphatase level, number of disease sites (≤ three), and the absence of visceral metastases. By adjusting for these prognostic factors, the HR was 0.99 for overall survival and 1.01 for progression-free survival. The 5-year overall survival rates for patients with and without visceral metastases were 6.8% and 20.9%, respectively. Conclusion Long-term overall and progression-free survival after treatment with GC or MVAC are similar. These results strengthen the role of GC as a standard of care in patients with locally advanced or metastatic TCC.

scholarly journals IMRT Images Based on Swarm Intelligence Algorithm in the Treatment of Nasopharyngeal Carcinoma and Pain

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xiaoli Fu ◽  
Minxiang Li ◽  
Mantian Yin ◽  
Qing Li ◽  
Ying Chen
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Total Dose ◽  
Survival Rates ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Target Volume ◽  
Acute Radiation ◽  
Free Survival ◽  
Sliding Windows ◽  
Technical Features

Objective. To investigate the IMRT treatment of nasopharyngeal carcinoma term effect, toxicity, and technical features. Methods. Sliding windows dynamic CT image-guided IMRT techniques on 31 patients for treatment of nasopharyngeal carcinoma radical radiotherapy, with 30 to 33 min irradiation. Target prescription dose GTVnx, GTVnd, CTV1, and CTV2 were 70∼76Gy, 68∼70Gy, 60∼66Gy, and 54Gy, while giving a dose of vital organs, the brain stem, and other restrictions to protect the parotid gland. Results. During 3 to 18 months of follow-up for a median period of 10 months, 1-year locoregional patients’ progression-free survival, distant metastasis-free survival, and overall survival rates were 93.5%, 87.1%, and 93.5%, respectively. Acute radiation reactions of grade I and II, xerostomia, and radioactive stomatitis were not observed. IMRT DVH analysis showed increased total dose and the irradiation target volume divided doses, reduced OARs illuminated, and the total dose divided doses. Conclusion. Intensity-modulated radiation therapy can achieve good short-term effects, significantly reduce the acute radiation response, and improve the quality of life of patients. It is worthy of promotion and application and in-depth research.

Neoadjuvant versus concurrent chemotherapy in the management of carcinoma nasopharynx

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17053-e17053 ◽  
Author(s):  
R. Sharma ◽  
D. Kumar ◽  
S. Kaur ◽  
P. Kalsotra ◽  
A. Gupta
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Concurrent Chemotherapy ◽  
Concurrent Chemoradiation ◽  
Free Survival ◽  
The Impact ◽  
Disease Free

e17053 Background: Chemotherapy is added to radiotherapy in the treatment of nasopharyngeal carcinoma with advanced locoregional disease to enhance therapeutic gain. Thirty percent patients with locally advanced nasopharyngeal carcinoma (LA-NPC) still die of distant metastases despite concurrent chemoradiation being the standard of care. In this retrospective study we performed the pooled analysis of these patients to assess the impact of neoadjuvant chemotherapy versus the concurrent chemoradiation approach. Methods: Between January 2000 and December 2007, 45 patients of stage IIB- IVB nasopharyngeal were treated with 3 cycles of induction chemotherapy with cisplatin and 5FU (n = 23) followed by conventional radical radiotherapy, or concurrent chemoradiation with weekly cisplatin (n = 22). Results: Total numbers of patients eligible for analyses were 45. Median age of the patients was 52 years (range 19–76 years). Median follow up was 17 months (range 6–60 months). At the time of last follow up, 13 patients (out of 23, i.e. 56.53%) were alive and disease free in the neoadjuvant group and 13 patients (out of 22, i.e. 59.1%) were alive and disease free in the concurrent chemoradiation group. The 2-year failure free survival in the concurrent chemoradiation arm was 63% versus 35% in the neoadjuvant arm (p = 0.197). Survival analyses adjusted for the gender male revealed 2-year failure free survival as 81% in the concurrent chemoradiation versus 44% in the neoadjuvant chemotherapy group among male patients (p = 0.0143). On multivariate analysis age and stage were the two significant predictive factors for failure free survival. Conclusions: The neoadjuvant chemotherapy seems to be at least as effective as concurrent chemoradiation in this small cohort of patients. No significant financial relationships to disclose.

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