Regionally advanced nasopharyngeal carcinoma

Long-term outcome after sequential chemotherapy and radiotherapy

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Abstract

Aims and background: To evaluate the long-term clinical outcome of 61 patients with regionally advanced nasopharyngeal carcinoma treated with sequential chemotherapy and radiotherapy within a phase II trial. Methods: The trial evaluated a combined modality regimen including 3 cycles of induction polychemotherapy (epirubicin 70 mg/m2 d1, and cisplatin 100 mg/m 2 d1, both recycled every 3 weeks) followed by definitive radiotherapy to the primary site (64-70 Gy) and the neck (50-70 Gy). Patients included in the trial had pathologically confirmed nasopharyngeal carcinoma; stage (UICC 1987) T-any, N2-3, MO; ECOG performance status 0-1. Sixty-one patients were enrolled between 1990 and 1996; stage according to UICC 1997 was IIb in 8%, III in 36% and IV in 56% of the patients; histology was WHO type 1-2 in 11% and WHO type 3 in 89% of cases. Minimum follow-up of 33 surviving patients is 5.2 years. Results: Clinical failure has been observed in 30 patients (49%): initial failure, observed within the third year of follow-up in all but one case, was local alone in 6 (20%), regional alone in 10 (33%), local and regional in 1 (3%), regional and distant in 1 (3%), and distant alone in 12 patients (40%). Seven patients received salvage surgery to the neck, 2 of them still disease-free at 10 and 11 years from salvage surgery; 4 patients with an isolated local relapse were re-irradiated, and one of them was alive and well at 6.5 years from salvage radiation. At 5-year local control, regional control and distant metastasis-free rates were 83%, 74% and 73%, respectively; overall and disease-free survival were 64% and 51%. Late effects of initial treatment, as evaluated in 30 patients surviving 5 years without relapse, were generally acceptable, but some degree of xerostomia, dental damage, trismus and hearing loss were reported by a significant proportion of patients (respectively 100%, 88%, 76% and 86%). Conclusions: In our experience, long-term clinical cure of regionally advanced nasopharyngeal carcinoma was obtained in 51% of cases treated with chemotherapy and radiotherapy. Salvage treatments (neck surgery, local re-irradiation) are worthy, as they increase the cure rate by approximately 10%, raising 5-year survival to over 60%. Late effects are significant, calling for refinements in radiation technique, better integration with chemotherapy to possibly decrease the need for higher radiation dose, and/or use of effective radioprotectants.

Original languageEnglish
Pages (from-to)60-65
Number of pages6
JournalTumori
Volume90
Issue number1
Publication statusPublished - Jan 2004

Fingerprint

Radiotherapy
Drug Therapy
Neck
Radiation
Nasopharyngeal carcinoma
Trismus
Recurrence
Tooth Loss
Xerostomia
Salvage Therapy
Epirubicin
Combination Drug Therapy
Hearing Loss
Cisplatin
Disease-Free Survival
Histology
Neoplasm Metastasis
Survival

Keywords

  • Chemotherapy
  • Late effects
  • Nasopharyngeal carcinoma
  • Patterns of failure
  • Radiotherapy

ASJC Scopus subject areas

  • Cancer Research

Cite this

@article{3d4a05cb524545d790fa766a7009f0a5,
title = "Regionally advanced nasopharyngeal carcinoma: Long-term outcome after sequential chemotherapy and radiotherapy",
abstract = "Aims and background: To evaluate the long-term clinical outcome of 61 patients with regionally advanced nasopharyngeal carcinoma treated with sequential chemotherapy and radiotherapy within a phase II trial. Methods: The trial evaluated a combined modality regimen including 3 cycles of induction polychemotherapy (epirubicin 70 mg/m2 d1, and cisplatin 100 mg/m 2 d1, both recycled every 3 weeks) followed by definitive radiotherapy to the primary site (64-70 Gy) and the neck (50-70 Gy). Patients included in the trial had pathologically confirmed nasopharyngeal carcinoma; stage (UICC 1987) T-any, N2-3, MO; ECOG performance status 0-1. Sixty-one patients were enrolled between 1990 and 1996; stage according to UICC 1997 was IIb in 8{\%}, III in 36{\%} and IV in 56{\%} of the patients; histology was WHO type 1-2 in 11{\%} and WHO type 3 in 89{\%} of cases. Minimum follow-up of 33 surviving patients is 5.2 years. Results: Clinical failure has been observed in 30 patients (49{\%}): initial failure, observed within the third year of follow-up in all but one case, was local alone in 6 (20{\%}), regional alone in 10 (33{\%}), local and regional in 1 (3{\%}), regional and distant in 1 (3{\%}), and distant alone in 12 patients (40{\%}). Seven patients received salvage surgery to the neck, 2 of them still disease-free at 10 and 11 years from salvage surgery; 4 patients with an isolated local relapse were re-irradiated, and one of them was alive and well at 6.5 years from salvage radiation. At 5-year local control, regional control and distant metastasis-free rates were 83{\%}, 74{\%} and 73{\%}, respectively; overall and disease-free survival were 64{\%} and 51{\%}. Late effects of initial treatment, as evaluated in 30 patients surviving 5 years without relapse, were generally acceptable, but some degree of xerostomia, dental damage, trismus and hearing loss were reported by a significant proportion of patients (respectively 100{\%}, 88{\%}, 76{\%} and 86{\%}). Conclusions: In our experience, long-term clinical cure of regionally advanced nasopharyngeal carcinoma was obtained in 51{\%} of cases treated with chemotherapy and radiotherapy. Salvage treatments (neck surgery, local re-irradiation) are worthy, as they increase the cure rate by approximately 10{\%}, raising 5-year survival to over 60{\%}. Late effects are significant, calling for refinements in radiation technique, better integration with chemotherapy to possibly decrease the need for higher radiation dose, and/or use of effective radioprotectants.",
keywords = "Chemotherapy, Late effects, Nasopharyngeal carcinoma, Patterns of failure, Radiotherapy",
author = "Mauro Palazzi and Marco Guzzo and Paolo Bossi and Stefano Tomatis and Annamaria Cerrotta and Giulio Cant{\'u} and Locati, {Laura D.} and Lisa Licitra",
year = "2004",
month = "1",
language = "English",
volume = "90",
pages = "60--65",
journal = "Tumori",
issn = "0300-8916",
publisher = "SAGE Publications Ltd",
number = "1",

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TY - JOUR

T1 - Regionally advanced nasopharyngeal carcinoma

T2 - Long-term outcome after sequential chemotherapy and radiotherapy

AU - Palazzi, Mauro

AU - Guzzo, Marco

AU - Bossi, Paolo

AU - Tomatis, Stefano

AU - Cerrotta, Annamaria

AU - Cantú, Giulio

AU - Locati, Laura D.

AU - Licitra, Lisa

PY - 2004/1

Y1 - 2004/1

N2 - Aims and background: To evaluate the long-term clinical outcome of 61 patients with regionally advanced nasopharyngeal carcinoma treated with sequential chemotherapy and radiotherapy within a phase II trial. Methods: The trial evaluated a combined modality regimen including 3 cycles of induction polychemotherapy (epirubicin 70 mg/m2 d1, and cisplatin 100 mg/m 2 d1, both recycled every 3 weeks) followed by definitive radiotherapy to the primary site (64-70 Gy) and the neck (50-70 Gy). Patients included in the trial had pathologically confirmed nasopharyngeal carcinoma; stage (UICC 1987) T-any, N2-3, MO; ECOG performance status 0-1. Sixty-one patients were enrolled between 1990 and 1996; stage according to UICC 1997 was IIb in 8%, III in 36% and IV in 56% of the patients; histology was WHO type 1-2 in 11% and WHO type 3 in 89% of cases. Minimum follow-up of 33 surviving patients is 5.2 years. Results: Clinical failure has been observed in 30 patients (49%): initial failure, observed within the third year of follow-up in all but one case, was local alone in 6 (20%), regional alone in 10 (33%), local and regional in 1 (3%), regional and distant in 1 (3%), and distant alone in 12 patients (40%). Seven patients received salvage surgery to the neck, 2 of them still disease-free at 10 and 11 years from salvage surgery; 4 patients with an isolated local relapse were re-irradiated, and one of them was alive and well at 6.5 years from salvage radiation. At 5-year local control, regional control and distant metastasis-free rates were 83%, 74% and 73%, respectively; overall and disease-free survival were 64% and 51%. Late effects of initial treatment, as evaluated in 30 patients surviving 5 years without relapse, were generally acceptable, but some degree of xerostomia, dental damage, trismus and hearing loss were reported by a significant proportion of patients (respectively 100%, 88%, 76% and 86%). Conclusions: In our experience, long-term clinical cure of regionally advanced nasopharyngeal carcinoma was obtained in 51% of cases treated with chemotherapy and radiotherapy. Salvage treatments (neck surgery, local re-irradiation) are worthy, as they increase the cure rate by approximately 10%, raising 5-year survival to over 60%. Late effects are significant, calling for refinements in radiation technique, better integration with chemotherapy to possibly decrease the need for higher radiation dose, and/or use of effective radioprotectants.

AB - Aims and background: To evaluate the long-term clinical outcome of 61 patients with regionally advanced nasopharyngeal carcinoma treated with sequential chemotherapy and radiotherapy within a phase II trial. Methods: The trial evaluated a combined modality regimen including 3 cycles of induction polychemotherapy (epirubicin 70 mg/m2 d1, and cisplatin 100 mg/m 2 d1, both recycled every 3 weeks) followed by definitive radiotherapy to the primary site (64-70 Gy) and the neck (50-70 Gy). Patients included in the trial had pathologically confirmed nasopharyngeal carcinoma; stage (UICC 1987) T-any, N2-3, MO; ECOG performance status 0-1. Sixty-one patients were enrolled between 1990 and 1996; stage according to UICC 1997 was IIb in 8%, III in 36% and IV in 56% of the patients; histology was WHO type 1-2 in 11% and WHO type 3 in 89% of cases. Minimum follow-up of 33 surviving patients is 5.2 years. Results: Clinical failure has been observed in 30 patients (49%): initial failure, observed within the third year of follow-up in all but one case, was local alone in 6 (20%), regional alone in 10 (33%), local and regional in 1 (3%), regional and distant in 1 (3%), and distant alone in 12 patients (40%). Seven patients received salvage surgery to the neck, 2 of them still disease-free at 10 and 11 years from salvage surgery; 4 patients with an isolated local relapse were re-irradiated, and one of them was alive and well at 6.5 years from salvage radiation. At 5-year local control, regional control and distant metastasis-free rates were 83%, 74% and 73%, respectively; overall and disease-free survival were 64% and 51%. Late effects of initial treatment, as evaluated in 30 patients surviving 5 years without relapse, were generally acceptable, but some degree of xerostomia, dental damage, trismus and hearing loss were reported by a significant proportion of patients (respectively 100%, 88%, 76% and 86%). Conclusions: In our experience, long-term clinical cure of regionally advanced nasopharyngeal carcinoma was obtained in 51% of cases treated with chemotherapy and radiotherapy. Salvage treatments (neck surgery, local re-irradiation) are worthy, as they increase the cure rate by approximately 10%, raising 5-year survival to over 60%. Late effects are significant, calling for refinements in radiation technique, better integration with chemotherapy to possibly decrease the need for higher radiation dose, and/or use of effective radioprotectants.

KW - Chemotherapy

KW - Late effects

KW - Nasopharyngeal carcinoma

KW - Patterns of failure

KW - Radiotherapy

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M3 - Article

VL - 90

SP - 60

EP - 65

JO - Tumori

JF - Tumori

SN - 0300-8916

IS - 1

ER -