Concomitant radiotherapy and chemotherapy for early-stage nasopharyngeal carcinoma

Purpose: Early-stage nasopharyngeal carcinoma (NPC) continues to carry a fa ilure rate of 15% to 30% when treated with radiotherapy alone; the benefit of concomitant radiotherapy and chemotherapy (CCRT) in early-stage NPC is u nclear. The purpose of this report is to describe our efforts to improve tr eatment outcome in early-stage NPC after CCRT. Patients and Methods: Of 189 newly diagnosed NPC patients without evidence of distant metastases who were treated in our institution between 1990 and 1997, 44 presented with early-stage (stage I and II) disease according to t he American Joint Committee on Cancer (AJCC) 1997 NPC staging system. Twelv e of these patients were treated with radiotherapy alone and 32 with CCRT. Each patient's head and neck area was evaluated by magnetic resonance imagi ng or computed tomography. Radiotherapy was administered at 2 Gy per fracti on per day, Monday through Friday, for 35 fractions for a total dose of 70 Gy. Chemotherapy consisting of cis-diamine-dichloroplatinum and fluorouraci l was delivered simultaneously with radiotherapy in weeks 1 and 6 and seque ntially for two monthly cycles after radiotherapy. Results: Patients who were treated with radiotherapy alone primarily had st age I disease, whereas none of those who were treated with CCRT had stage I disease (11 of 12 patients v none of 32 patients; P =.001). The locoregion al control rate at 3 years for the radiotherapy group was 91.7% (median fol low-up period, 34 months) and was 100% for the CCRT group (median follow-up period, 44 months) (P =.10). The 3-year disease-free survival rate in the radiotherapy group was 91.7% and was 96.9% in the CCRT group (P =.66). Conclusion: Our results reveal excellent prognosis of AJCC 1997 stage II NP C treated with CCRT. Stage II patients with a greater tumor burden treated with CCRT showed an equal disease-free survival, compared with stage I pati ents treated with radiotherapy alone. A prospective randomized trial is und erway to confirm the role of CCRT in stage II NPC. J Clin Oncol 18:2040-204 5. (C) 2000 by American Society of Clinical Oncology.