THE ROLE OF CHEMOTHERAPY IN THE MANAGEMENT OF NASOPHARYNGEAL CARCINOMA

BACKGROUND. Nasopharyngeal carcinoma (NPC) is a radiosensitive tumor f or which there is a high local control rate after radical radiotherapy (RT). However, for patients with locoregionally advanced disease, the rate of distant metastasis is high and the 5-year overall survival ra te is poor. METHODS. A review of retrospective and prospective clinica l studies was performed to assess the role of chemotherapy in three se ttings: metastatic disease; neoadjuvant and/or adjuvant; and concurren t chemotherapy with radiotherapy. RESULTS. Cisplatin-based combination chemotherapy results in a high response rate in patients with metasta tic NPC, and a subgroup may achieve long term disease free survival. T he use of neoadjuvant and adjuvant chemotherapy to treat locoregionall y advanced disease has resulted in consistently high response rates, b ut no randomized trial to date has demonstrated an improvement in over all survival. A recent Head and Neck Intergroup study randomized patie nts in the United States to receive concurrent chemotherapy (cisplatin ) and radiotherapy or radiotherapy only. Although this approach demons trated significant benefit in overall survival favoring the use of con current chemotherapy and radiotherapy, its applicability in geographic areas of high NPC incidence remains to be proven. CONCLUSIONS. NPC is a chemosensitive tumor, and patients with metastatic disease have a h igh response rate. Further prospective studies will define the standar d approach to treating locoregionally advanced NPC, which is likely to incorporate into the primary treatment some form of systemic chemothe rapy. (C) 1998 American Cancer Society.