Induction chemotherapy followed by alternating chemo-radiotherapy in stage IV undifferentiated nasopharyngeal carcinoma

M. Benasso, G. Sanguineti, M. D'Amico, R. Corvò, I. Ricci, G. Numico, D. Guarneri, V. Vitale, E. Pallestrini, A. Santelli, R. Rosso

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Abstract

In locally advanced undifferentiated nasopharyngeal carcinoma (UNPC), concomitant chemo-radiotherapy is the only strategy that gave better results over radiation alone in a phase III trial. Adding effective chemotherapy to a concomitant chemo-radiotherapy programme may be a way to improve the results further. 30 patients with previously untreated T4 and/or N2-3 undifferentiated nasopharyngeal carcinoma were consecutively enrolled and initially treated with 3 courses of epidoxorubicin, 90 mg/m2, day 1 and cisplatin, 40 mg/m2, days 1 and 2, every 3 weeks. After a radiological and clinical response assessment patients underwent 3 courses of cisplatin, 20 mg/m2/day, days 1-4 and fluorouracil, 200 mg/m2/day, days 1-4, i.v. bolus, (weeks 1, 4, 7) alternated to 3 courses of radiation (week 2-3, 5-6, 8-9-10), with a single daily fractionation, up to 70 Gy. WHO histology was type 2 in 30% and type 3 in 70% of the patients. 57% had T4 and 77% N2-3 disease. All the patients are evaluable for toxicity and response. All but one received 3 courses of induction chemotherapy. Toxicity was mild to moderate in any case. At the end of the induction phase 10% of CRs, 83.3% of PRs and 6.7% of SD were recorded. All the patients but one had the planned number of chemotherapy courses in the alternating phase and all received the planned radiation dose. One patient out of 3 developed grade III-IV mucositis. Haematological toxicity was generally mild to moderate. At the final response evaluation 86.7% of CRs and 13.3% of PRs were observed. At a median follow-up of 31 months, 13.3% of patients had a loco-regional progression and 20% developed distant metastases. The 3-year actuarial progression-free survival and overall survival rates were 64% and 83%. Induction chemotherapy followed by alternating chemo-radiotherapy is feasible and patients' compliance optimal. This approach showed a very promising activity on locally advanced UNPC and merits to be investigated in phase Ill studies. (C) 2000 Cancer Research Campaign.

Original languageEnglish
Pages (from-to)1437-1442
Number of pages6
JournalBritish Journal of Cancer
Volume83
Issue number11
Publication statusPublished - 2000

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Induction Chemotherapy
Radiotherapy
Carcinoma
Radiation
Cisplatin
Drug Therapy
Mucositis
Patient Compliance
Nasopharyngeal carcinoma
Fluorouracil
Disease-Free Survival
Histology
Survival Rate
Neoplasm Metastasis

Keywords

  • Chemo-radiotherapy
  • Combined treatments
  • Nasopharyngeal carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Induction chemotherapy followed by alternating chemo-radiotherapy in stage IV undifferentiated nasopharyngeal carcinoma. / Benasso, M.; Sanguineti, G.; D'Amico, M.; Corvò, R.; Ricci, I.; Numico, G.; Guarneri, D.; Vitale, V.; Pallestrini, E.; Santelli, A.; Rosso, R.

In: British Journal of Cancer, Vol. 83, No. 11, 2000, p. 1437-1442.

Research output: Contribution to journalArticle

Benasso, M, Sanguineti, G, D'Amico, M, Corvò, R, Ricci, I, Numico, G, Guarneri, D, Vitale, V, Pallestrini, E, Santelli, A & Rosso, R 2000, 'Induction chemotherapy followed by alternating chemo-radiotherapy in stage IV undifferentiated nasopharyngeal carcinoma', British Journal of Cancer, vol. 83, no. 11, pp. 1437-1442.
Benasso, M. ; Sanguineti, G. ; D'Amico, M. ; Corvò, R. ; Ricci, I. ; Numico, G. ; Guarneri, D. ; Vitale, V. ; Pallestrini, E. ; Santelli, A. ; Rosso, R. / Induction chemotherapy followed by alternating chemo-radiotherapy in stage IV undifferentiated nasopharyngeal carcinoma. In: British Journal of Cancer. 2000 ; Vol. 83, No. 11. pp. 1437-1442.
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AU - D'Amico, M.

AU - Corvò, R.

AU - Ricci, I.

AU - Numico, G.

AU - Guarneri, D.

AU - Vitale, V.

AU - Pallestrini, E.

AU - Santelli, A.

AU - Rosso, R.

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N2 - In locally advanced undifferentiated nasopharyngeal carcinoma (UNPC), concomitant chemo-radiotherapy is the only strategy that gave better results over radiation alone in a phase III trial. Adding effective chemotherapy to a concomitant chemo-radiotherapy programme may be a way to improve the results further. 30 patients with previously untreated T4 and/or N2-3 undifferentiated nasopharyngeal carcinoma were consecutively enrolled and initially treated with 3 courses of epidoxorubicin, 90 mg/m2, day 1 and cisplatin, 40 mg/m2, days 1 and 2, every 3 weeks. After a radiological and clinical response assessment patients underwent 3 courses of cisplatin, 20 mg/m2/day, days 1-4 and fluorouracil, 200 mg/m2/day, days 1-4, i.v. bolus, (weeks 1, 4, 7) alternated to 3 courses of radiation (week 2-3, 5-6, 8-9-10), with a single daily fractionation, up to 70 Gy. WHO histology was type 2 in 30% and type 3 in 70% of the patients. 57% had T4 and 77% N2-3 disease. All the patients are evaluable for toxicity and response. All but one received 3 courses of induction chemotherapy. Toxicity was mild to moderate in any case. At the end of the induction phase 10% of CRs, 83.3% of PRs and 6.7% of SD were recorded. All the patients but one had the planned number of chemotherapy courses in the alternating phase and all received the planned radiation dose. One patient out of 3 developed grade III-IV mucositis. Haematological toxicity was generally mild to moderate. At the final response evaluation 86.7% of CRs and 13.3% of PRs were observed. At a median follow-up of 31 months, 13.3% of patients had a loco-regional progression and 20% developed distant metastases. The 3-year actuarial progression-free survival and overall survival rates were 64% and 83%. Induction chemotherapy followed by alternating chemo-radiotherapy is feasible and patients' compliance optimal. This approach showed a very promising activity on locally advanced UNPC and merits to be investigated in phase Ill studies. (C) 2000 Cancer Research Campaign.

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