Improved outcome secondary to concurrent chemoradiotherapy for advanced carcinoma of the nasopharynx: Preliminary corroboration of the intergroup experience

Purpose: The recent Intergroup 0099 trial of concurrent chemoradiotherapy f or advanced nasopharyngeal carcinomas, demonstrated improved survival for c hemoradiotherapy as compared to radiation therapy alone. Following closure of this study, we adopted the chemoradiotherapy regimen used in 0099 as our standard of practice. We herein report our recent institutional results, r epresenting a relatively large uniformly treated cohort. Methods and Materials: Between 1995 and 1997, 35 consecutive patients, who had clinically nondisseminated Stage III or IV nasopharyngeal cancer, were treated by chemoradiotherapy. The prescribed radiation regimen was 7000 cGy delivered in 35 fractions over 7 weeks to all macroscopic disease and 5000 cGy to areas considered at risk of harboring microscopic disease. Chemothe rapy was designed to deliver cisplatin (100 mg/m(2) i.v.) on Days 1, 22, an d 43 of radiation therapy and cisplatin (80 mg/m(2) i.v.) on Days 71, 99, a nd 127 plus flurouracil (5-FU; 1 g/m(2)/day by 96-h infusion) on Days 71-74 , 99-102, and 127-130. Results: All patients had at least a partial response (PR) to treatment, in cluding an 85% complete response (CR) rate, The actuarial 3-year overall su rvival rate was 93% and the disease-free survival rate was 65%. Both repres ent substantial improvements over our institutional historical controls tre ated by radiation therapy alone and both are similar to the rates observed in the Intergroup trial. Conclusion: Our data support the conclusion that concurrent chemoradiothera py followed by adjuvant chemotherapy (as was used in Intergroup 0099) shoul d be considered the current standard of care for patients who have advanced cancers of the nasopharynx, (C) 2000 Elsevier Science Inc.