Long-term survival of nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy

Purpose: The purpose of this study is to demonstrate long-term survival of nasopharyngeal carcinoma treated with concomitant chemotherapy and radiothe rapy (CCRT) followed by adjuvant chemotherapy. Methods and Patients: One hundred and seven patients with Stage III and IV (American Joint Committee on Cancer, AJCC, 1988) nasopharyngeal carcinoma ( NPC) were treated with concomitant chemotherapy and radiotherapy (CCRT) fol lowed by adjuvant chemotherapy between April 1990 and December 1997 in Koo Foundation Sun Yat-Sen Cancer Center, Taipei. The dose of radiation was 70 Gray (Gy) given in 35 fractions, 5 fractions per week, Two courses of chemo therapy, consisting of cisplatin and 5-fluorouracil, were delivered simulta neously with radiotherapy in Weeks 1 and 6 and two additional monthly cours es were given after radiotherapy. According to the AJCC 1997 staging system , 32 patients had Stage II disease, 44 had Stage III, and 31 had Stage IV d isease. Results: With median follow-up of 44 months, the 5-year overall survival ra te in all 107 patients was 84.1%, disease-free survival rate was 74.4%, and locoregional control rate was 89.8%. The 3-year overall survival for Stage II was 100% for Stage III it was 92.8%, and for Stage IV, 69.4% (p = 0.000 2). The 3-year disease-free survival for Stage II was 96.9 %, for Stage III it was 87.7%, and for Stage IV it was 51.9% (p = 0.0001). Conclusion: CCRT and adjuvant chemotherapy is effective in Taiwanese patien ts with advanced NPC. The prognosis of AJCC 1997 Stage II and III disease i s excellent, but, for Stage IV (M0), it is relatively poor. Future strategi es of therapy should focus on high-risk AJCC 1997 Stage IV (M0) cohort. (C) 2000 Elsevier Science Inc.