DOES INDUCTION CHEMOTHERAPY HAVE A ROLE IN THE MANAGEMENT OF NASOPHARYNGEAL CARCINOMA - RESULTS OF TREATMENT IN THE ERA OF COMPUTERIZED-TOMOGRAPHY

Purpose: To assess the outcomes of patients with nasopharyngeal carcin oma (NPC) whose treatment was determined by computerized tomography (C T) and/or magnetic resonance imaging staging and to analyze the impact of induction chemotherapy and accelerated fractionated radiotherapy. Methods and Materials: The analysis is based on 122 of 143 previously untreated patients with NPC treated with radiation therapy at The Univ ersity of Texas M. D. Anderson Cancer Center between 1983 and 1992. Ex cluded were 4 patients treated with palliative intent, 4 children, 12 patients not staged with CT, and 1 patient who died of a cerebrovascul ar accident prior to completion of treatment. The stage distribution w as as follows: AJCC Stage I-2, Stage II-7, Stage III-12, Stage IV-101; T1-15, T2-33, T3-22, T4-52; N0-32, N1-10, N2-47, N3-32, Nx-1. Fifty-n ine (48%) patients had squamous cell carcinoma; 63 (52%) had lymphoepi theliomas, undifferentiated NPC or poorly differentiated carcinoma, NO S (UNPC). Sixty-seven patients (65 with Stage IV disease) received ind uction chemotherapy. Fifty-eight patients (24 of whom had induction ch emotherapy) were treated with the concomitant boost fractionation sche dule. The median follow-up for surviving patients was 57 months. Resul ts: The overall actuarial 2- and 5-year survival rates were 78 and 68% , respectively. Forty-nine patients (40%) had disease recurrence. Thir ty-three (27%) had local regional failures; 19 at the primary site onl y, 8 in the neck and 6 in both. Local failure occurred in 31% of patie nts staged T4 compared to 13% of T1-T3 (p = 0.007). Sixteen patients f ailed at distant sites alone. Among Stage IV patients the 5-year actua rial rates for patients who did and did not receive induction chemothe rapy were as follows: overall survival: 68 vs. 56% (p = 0.02), freedom from relapse: 64 vs. 37% (p = 0.01), and local control: 86 vs. 56% (p = 0.009). The actuarial 5-year distant failure rate in patients with UNPC who were treated with induction chemotherapy and controlled in th e primary and neck was 13%. In patients who did not receive chemothera py, the actuarial 5-year local control rates for patients treated with concomitant boost or conventional fractionation were 66 and 67%, resp ectively. Conclusions: While not providing conclusive evidence, this s ingle institution experience suggests that neoadjuvant chemotherapy fo r Stage IV NPC patients improves both survival and disease control. Re currence within the irradiated volume was the most prevalent mode of f ailure and future studies will evaluate regimens to enhance local regi onal control. Copyright (C) 1996 Elsevier Science Inc.