[Concurrent chemoradiotherapy followed by adjuvant chemotherapy for stage III-IVa nasopharyngeal carcinoma].

OBJECTIVE

Most studies on chemoradiotherapy for advanced nasopharyngeal carcinoma (NPC) showed that induction chemotherapy before radiotherapy could not improve the survival of the patients, but the effect of adjuvant chemotherapy after radiotherapy on advanced NPC is uncertain. A study showed that concurrent chemoradiotherapy could improve the prognosis of advanced NPC. This study was to evaluate the efficacy of concurrent chemoradiotherapy followed by adjuvant chemotherapy on stage III-IVa nasopharyngeal carcinoma (NPC).

METHODS

A total of 80 patients with stage III-IVa NPC were randomized into test group (40 patients) and control group (40 patients). Test group received concurrent chemotherapy of weekly cisplatin (25 mg/m2) for 6 weeks, and conventional radiotherapy of standard fractionation at 2 Gy/day to a total of 70 Gy to the nasopharynx, followed by adjuvant chemotherapy of cisplatin (25 mg/m2) and 5-fluorouracil (1000 mg/m2) daily for 3 days and repeated every 3 weeks for 3 cycles. Control group received only conventional radiotherapy.

RESULTS

After treatment, 34 patients in test group and 32 in control group achieved complete remission (CR) (P>0.05); the CR rate of neck lymph node was significantly higher in test group than in control group (92.5% vs. 75.0%, P<0.05). The 1-, 3-, 5-year overall survival rates were significantly higher in test group than in control group (92.7% vs. 81.2%, 78.6% vs. 52.7%, 64.2% vs. 42.3%, P<0.01). The 1-, 3-, 5-year disease-free survival rates were significantly higher in test group than in control group (91.2% vs. 78.2%, 76.7% vs. 51.9%, 63.5% vs. 40.3%, P<0.01). The 5-year distant metastasis rate was significantly lower in test group than in control group (15.0% vs. 35.0%, P<0.05). Grade III mucositis was more frequently observed in test group than in control group (75.0% vs. 25.0%, P<0.01).

CONCLUSIONS

Concurrent chemoradiotherapy followed by adjuvant chemotherapy could improve the CR rate of neck lymph node, overall survival, and disease-free survival of stage III-IVa NPC patients, suppress distant metastasis, but increase the risk of grade III mucositis.