Nasopharyngeal cancer (NPC) is radiosensitive and chemosensitive. We evaluated the efficacy of alternating chemoradiotherapy in patients with advanced NPC.
Methods:
Alternating chemoradiotherapy was initiated in 30 patients with NPC, and 27 patients with cancer stages II (n = 6), III (n = 8), IVA (n = 9), and IVB (n = 4) were retrospectively analyzed. Chemotherapy was initially administered followed by radiotherapy, and chemotherapy, radiotherapy, and chemotherapy were alternately administered. Of the 27 patients, 22 patients received cisplatin (50 mg/m2/day, days 6 and 7) and 5-fluorouracil (5-FU; 800 mg/m2/day, days 1-5), whereas 5 patients received carboplatin (AUC 4-5, day 6) and 5-FU.
Results:
Of the 27 patients, 19 (70%) received 3 chemotherapy courses. The total duration of alternating chemoradiotherapy was 81 to 101 days (median, 90 days). At a median follow-up of 53 months, the 5-year progression-free survival (PFS) was 71%. Multivariate analysis showed that weight loss and the number of chemotherapy courses had a significant effect on PFS.
Conclusion:
Alternating chemoradiotherapy led to similar or higher survival rates compared with concurrent chemoradiotherapy, which was characterized by good compliance and adaptable intensity.
SanadaKKimuraSFuharaT. In: ParkinDMWhelanSLFerlayJRaymondLYoungJ, eds. Cancer Incidence in Five Continents. Vol. 7. Lyon, France: IARC Scientific Publications; 1987:382-405.
2.
HoJHC. An epidemiological and clinical study of nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 1978;4:183-197.
3.
WangDCCaiWMHuVC. Long-term survival of 1035 cases of nasopharyngeal carcinoma. Cancer. 1988;61:2338-2341.
4.
QinDXHuYHYanJH. Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation. Cancer. 1988;61:1117-1124.
5.
MuronoSYoshizakiTParkCSFurukawaM. Association of Epstein-Barr virus infection with p53 protein accumulation but not bcl-2 protein in nasopharyngeal carcinoma. Histopathology. 1999;34(5):432-438.
6.
HoppeRTGoffinetDRBagshawMA. Carcinoma of the nasopharynx. Eighteen years’ experience with megavoltage radiation therapy. Cancer. 1976;37:2605-2612.
7.
PerezCAAckermanLVMillWBOguraJHPowersWE. Cancer of the nasopharynx. Factors influencing prognosis. Cancer. 1969;24:1-17.
8.
WangCCMeyerJE. Radiotherapeutic management of carcinoma of the nasopharynx. An analysis of 170 patients. Cancer. 1971;28:566-570.
9.
MarcialVAHanleyJAChangCDavisLWMoscolJA. Split-course radiation therapy of carcinoma of the nasopharynx: results of a national collaborative clinical trial of the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1980;6:409-414.
10.
YoshizakiTKondoSWakisakaN. Pathogenic role of Epstein-Barr virus latent membrane protein-1 in the development of nasopharyngeal carcinoma. Cancer Lett. 2013;337(1):1-7.
11.
GearaFBSanguinetiGTuckerSL. Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of distant metastasis and survival. Radiother Oncol. 1997;43:53-61.
12.
Al-SarrafMLeBlancMGiriPG. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16:1310-1317.
13.
FuwaNItoYKodairaT. Therapeutic results of alternating chemoradiotherapy for nasopharyngeal cancer using cisplatin and 5-fluorouracil: its usefulness and controversial points. Jpn J Clin Oncol. 2001;31:589-595.
14.
FuwaNShikamaNHayashiN. Treatment results of alternating chemoradiotherapy for nasopharyngeal cancer using cisplatin and 5-fluorouracil—a phase II study. Oral Oncol. 2007;43:948-955.
15.
Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events Version 3.0 (CTCAE). Bethesda, MD: National Cancer Institute, 2003.
16.
LeeAWLauWHTungSY. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol. 2005;23:6966-6975.
17.
WeeJTanEHTaiBC. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union Against Cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. 2005;23:6730-6738.
18.
ChenYLiuMZLiangSB. Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of China. Int J Radiat Oncol Biol Phys. 2008;71:1356-1364.
19.
RossiAMolinariRBoracchiP. Adjuvant chemotherapy with vincristine, cyclophosphamide, and doxorubicin after radiotherapy in local-regional nasopharyngeal cancer: results of a 4-year multicenter randomized study. J Clin Oncol. 1988;6:1401-1410.
20.
ChiKHChangYCGuoWY. A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients. Int J Radiat Oncol Biol Phys. 2002;52:1238-1244.
21.
LeeAWTungSYNganRK. Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: combined analyses of NPC-9901 and NPC-9902 trials. Eur J Cancer. 2011;47:656-666.
22.
LinJCJanJSHsuCYLiangWMJiangRSWangWY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003;21:631-637.
23.
RosenthalDI. Consequences of mucositis-induced treatment breaks and dose reductions on head and neck cancer treatment outcomes. J Support Oncol. 2007;5:23-31.
24.
DonaldsonSSLenonRA. Alterations of nutritional status: impact of chemotherapy and radiation therapy. Cancer. 1979;43:2036-2052.
25.
SuntharalingamMHaasMLVan EchoDA. Predictors of response and survival after concurrent chemotherapy and radiation for locally advanced squamous cell carcinomas of the head and neck. Cancer. 2001;91:548-554.
26.
LeeAWLinJCNgWT. Current management of nasopharyngeal cancer. Semin Radiat Oncol. 2012;22(3):233-244.
27.
BeaverMEMathenyKERobertsDBMyersJN. Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg. 2001;125:645-648.
