Nasopharyngeal carcinoma: Radiotherapy alone or in combination with chemotherapy?

Background: Between 1979 and 1997, a total of 92 patients with primary naso pharyngeal carcinoma were treated at the Hospitals of the University of Erl angen. Until 1988, radiotherapy alone was the treatment of choice and simul taneous radiochemotherapy was consistently applied thereafter. This retrosp ective analysis was performed to evaluate the influence of concurrent radio chemotherapy on survival and to identify possible prognostic factors on cau se-specific survival-, locoregional tumor control- and distant-metastases-f ree survival rates. Patients and Methods: Fifty-three patients (58%) received treatment by radi otherapy alone and 39 (42%) underwent primary radiochemotherapy with 2 cour ses of 5-FU and cisplatin. Median total dose to the bilateral neck region w as 60 Gy (range, 50 to 62 Gy), and 74 Gy (range, 56 to 88 Gy) to the primar y tumor. Median follow-up of the surviving patients was 8 years. Results: Following radiochemotherapy and radiotherapy alone, the 5-year-sur vival rates were 67% and 48%, respectively (p = 0.06). Female patients had a survival advantage as compared to male patients (5-year-survival rate 77% vs 44%, p = 0.01). Patients with and without cranial nerve palsy at presen tation had survival rates of 0% and 61%. respectively, at 5 pears (p = 0.01 ). Distant-metastases-free survival was influenced by the following factors : lymph-node involvement (NO: 82% vs N1 to N3: 68%, p = 0.04), gender (fema le: 88% vs male: 64%, p = 0.01), type of treatment (radiochemotherapy: 86% vs radiotherapy: 63%, p = 0.02) and cranial nerve involvement (76% without and 42% with involvement, p = 0.04). Conclusions: In primary nasopharyngeal carcinoma simultaneous radiochemothe rapy can significantly reduce distant metastases and improve survival as co mpared to radiotherapy alone. Since late toxicity rates were similiar in bo th treatment groups and the slightly increased acute side effects following radiochemotherapy were effectively compensated by standard supportive care , patients with advanced nasopharyngeal carcinoma may benefit from simultan eous radiochemotherapy.