CHEMOTHERAPY WITH CISPLATIN AND CONTINUOUS-INFUSION OF 5-FLUOROURACILAND BLEOMYCIN FOR RECURRENT AND METASTATIC NASOPHARYNGEAL CARCINOMA IN TAIWAN

Twenty-five patients with metastatic and/or recurrent nasopharyngeal c arcinoma were treated with cisplatin 20 mg/m2/day on days 1-5 i.v. wit h hydration; 5-fluorouracil (5-FU) 1,000 mg/m2/day by continuous infus ion (CI); and bleomycin 15 mg/m2 on day 1 also by Cl. These cycles wer e repeated every 4 weeks. Twenty-three (92%) had distant metastases. B one was the most frequently involved site (72%), followed by lungs (44 %) and liver (40%). More than half the patients (14/25) presented with at least 3 organ sites involved or had local T3/T4 or N3 lesions with a distant metastasis. The median time from relapse to start of chemot herapy was 7.5 months. We observed 1 (4%) complete response (CR), and 9 (36%) partial responses (PR). The objective response rate (CR+PR) wa s 40%. Hematologic toxicities were frequently encountered. Twenty (80% ) patients experienced leukopenia during the treatment courses and 9 ( 36%) had severe (grade 3 or 4) leukopenia. Eight patients had grade 3 or 4 infections. Two of them died of sepsis and 1 succumbed to uncontr olled pneumonia. The objective response rate was inferior to other ser ies. Possible explanation included longer delay before initiation of d efinitive treatment, larger tumor burdens, higher severe hematologic t oxicity and lower dosage of bleomycin. The results suggested metastati c and/or recurrent nasopharyngeal carcinoma is chemosensitive, however , for patients with large tumor burdens, more intensive chemotherapy r egimens with support of hematopoietic growth factors may be required t o achieve a better control.