Enhancement of local control in locally advanced node-positive nasopharyngeal carcinoma by adjunctive chemotherapy

Purpose: To determine the efficacy of chemotherapy adjunctive to radical radiotherapy (neoadjuvant ± adjuvant) in patients with node-positive nasopharyngeal carcinoma (NPC). Methods and Materials: All the node-positive patients given adjunctive chemotherapy between 1984–1989 ( n = 209, CHEMO) were compared with all the node-positive patients treated by radical radiotherapy alone during the same period ( n = 409, NCHEMO). The CHEMO group had significantly more bulky nodes, lower cervical/supraclavicular nodes, and more advanced overall stages than the NCHEMO group because nodal size (≥4 cm) was used as a selection criterion for chemotherapy (1984–1988 departmental protocol and 1988–1989 prospective randomized trial). The chemotherapy consisted of two courses of neoadjuvant cisplatin (100 mg/m 2 D1) and 5-fluorouracil (5-FU) (1 gm/m 2 D1–D3) in 191 patients. In addition to the two courses of neoadjuvant, four courses of adjuvant chemotherapy, of the same combination, were given after radical radiotherapy in a further 18 patients. Radical radiotherapy delivered a nasopharyngeal dose of 60–62.5 Gy. In addition, parapharyngeal booster external radiotherapy (20 Gy) was given in the presence of parapharyngeal involvement, and intracavitary brachytherapy (24 Gy) was used to treat any local residual tumor diagnosed at 4–6 weeks after external radiotherapy. Both crude and actuarial rates were compared (survival, distant metastases, and local failures) between CHEMO and NCHEMO for all patients, for individual Ho’s overall stage, for patients with nodes of different sizes (≤3 cm, >3–≤6 cm, >6 cm), for individual T-stage and individual N-stage, and for patients belonging to different gender and different age groups (