Concurrent chemoradiotherapy followed by adjuvant chemotherapy in Asian patients with nasopharyngeal carcinoma: Toxicities and preliminary results

Purpose: Nasopharyngeal carcinoma (NPC) is endemic in Singapore. Nearly 60% of the patients diagnosed with NPC will present with locally advanced dise ase. The North American Intergroup study 0099 reported improved survival ou tcome in patients with locally advanced NPC who received combined chemoradi otherapy when compared to radiotherapy alone. Hence we explored the feasibi lity and efficacy of a similar protocol in our patients. Methods and Materials: Between June 1996 and December 1997, 57 patients wer e treated with the following schedule as describe. Radical radiotherapy (RT ) of 66-70 Gy to the primary and neck with cisplatin (CDDP) 25 mg/m(2) on d ays 1-4 given by infusion over 6-8 hours daily on weeks 1, 4, and 7 of the RT. This is followed by a further 3 cycles of adjuvant chemotherapy startin g from week 11 from the first dose of radiation (CDDP 20 mg/m(2)/d and 5-fl uorouracil [5-FU] 1 gm/m(2)/d on days 1-4 every 28 days). Results: The majority of patients (68%) had Stage IV disease. About 54% of patients received all the intended treatment; 75% received all 3 cycles of CDDP during the RT phase and 63% received all three cycles of adjuvant chem otherapy. The received dose intensity of CDDP and 5-FU of greater than 0.8 was achieved in 58% and 60% of the patients respectively. Two treatment-rel ated deaths due to reactivation of hepatitis B and neutropenic sepsis respe ctively, were encountered. At median follow-up of 16 months, 14 patients ha d relapsed, 12 systemically and 2 loco-regionally. Conclusion: Due to the acceptable tolerability of such a protocol in our co hort of patients, we have embarked on a Phase III study to confirm the resu lts of the 0099 Intergroup study in the Asian context. (C) 1999 Elsevier Sc ience Inc.