Induction chemotherapy followed by alternating chemo-radiotherapy in stageIV undifferentiated nasopharyngeal carcinoma

In locally advanced undifferentiated nasopharyngeal carcinoma (UNPC), conco mitant chemo-radiotherapy is the only strategy that gave better results ove r radiation alone in a phase III trial. Adding effective chemotherapy to a concomitant chemo-radiotherapy programme may be a way to improve the result s further. 30 patients with previously untreated T4 and/or N2-3 undifferent iated nasopharyngeal carcinoma were consecutively enrolled and initially tr eated with 3 courses of epidoxorubicin, 90 mg/m2, day 1 and cisplatin, 40 m g/m2, days 1 and 2, every 3 weeks. After a radiological and clinical respon se assessment patients underwent 3 courses of cisplatin, 20 mg/m2/day, days 1-4 and fluorouracil, 200 mg/m2/day, days 1-4, i.v. bolus, (weeks 1, 4, 7) alternated to 3 courses of radiation (week 2-3, 5-6, 8-9-10), with a singl e daily fractionation, up to 70 Gy, WHO histology was type 2 in 30% and typ e 3 in 70% of the patients. 57% had T4 and 77% N2-3 disease. All the patien ts are evaluable for toxicity and response. All but one received 3 courses of induction chemotherapy. Toxicity was mild to moderate in any case. At th e end of the induction phase 10% of CRs, 83.3% of PRs and 6.7% of SD were r ecorded. All the patients but one had the planned number of chemotherapy co urses in the alternating phase and all received the planned radiation dose. One patient out of 3 developed grade Ill-IV mucositis, Haematological toxi city was generally mild to moderate. At the final response evaluation 86.7% of CRs and 13.3% of PRs were observed, At a median follow-up of 31 months, 13.3% of patients had a loco-regional progression and 20% developed distan t metastases. The 3-year actuarial progression-free survival and overall su rvival rates were 64% and 63%. Induction chemotherapy followed by alternati ng chemo-radiotherapy is feasible and patients' compliance optimal. This ap proach showed a very promising activity on locally advanced UNPC and merits to be investigated in phase III studies. (C) 2000 Cancer Research Campaign http://www.bjcancer.com.