Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma

Purpose: To analyze the impact of neoadjuvant chemotherapy on the treatment of locoregionally advanced nasopharyngeal carcinoma and to assess the outc omes of patients receiving such treatment. Methods and Materials: We analyzed 137 previously untreated and histologica lly confirmed advanced stage nasopharyngeal carcinoma patients treated with either radiation therapy only or combined radiation therapy and chemothera py at the Seoul National University Hospital between 1984 and 1996. The sta ge distribution was as follows: AJCC Stage III-21, Stage IV-61 in the radia tion therapy group (RT group); AJCC Stage III-1, Stage IV-54 in neoadjuvant chemotherapy and radiation therapy group (CT/RT group). The median follow- up for surviving patients was 48 months. Results: The 5-year overall survival (OS) rates were 71% for the CT/RT grou p and 59% for the RT group (p 0.04). The 5-year actuarial disease-free surv ival (DFS) rates were 63% for the CT/RT group and 52% for the RT group (p = 0.04). Distant metastasis (DM) incidence was significantly lower in the CT /RT group. The 5-year freedom from distant metastasis rates were 84% for th e CT/RT group and 66% for the RT group (p = 0.01). The incidence of locoreg ional failures was also lower in the CT/RT group, although this difference did not reach statistical significance (69% vs. 56%, p = 0.09) Conclusion: While not providing conclusive evidence, historical evidence fr om this institution suggests that neoadjuvant chemotherapy significantly im proves both overall and the disease-free survival of patients with advanced stage nasopharyngeal carcinoma. (C) 1999 Elsevier Science Inc.