Induction chemotherapy with paclitaxel and cisplatin, followed by concomitant cisplatin and radiotherapy for the treatment of locally advanced nasopharyngeal carcinoma

Purpose : To evaluate the efficacy and outcome of neoadjuvant paclitaxel and cisplatin chemotherapy fol-lowed by concurrent cisplatin and irradiation in patients with locally advanced nasopharyngeal (NP) squamous cell carcinoma. Patients and Methods : The trial included 36 patients with locally advanced nasopharyngeal squamous carcinoma presented to Radiation Oncology and Otolaryngology departments-Ain Shams university hospitals, and Sohag Cancer Center between November 2002 and March 2006. Eligible patients were treated first with three cycles of induction chemotherapy (IC), paclitaxel (175mg / m2 on day 1) and cisplatin (80mg / m2 on day 1) followed by concomitant conventionally fractionated radiation (70Gy in 2Gy fractions) and cisplatin 20-mg / m2 / day on days 1-5, 22-26 and 43-47 of the radiation therapy. Results : Twenty nine patients (80 %) and 32 patients (89 %) achieved objective response after IC and concom¬itant chemoradiation (CCRT) respectively. The actuarial 3 years survival was 68 %, and the actuarial 3 year pro¬gression free survival (PFS) was 66 %. Survival and PFS were significantly better for patients with smaller tumor volume (stage III), compared with patients with stage I V. Thirteen patients (36 %) have elements of local and / or regional failure and 5 patients (14 %) have an element of distant metastasis. Neutropenia (25 %), mucositis (22 %) and vomiting (20 %) were the most severe toxicities re¬corded (grade 3 and 4) during IC while mucositis (36 %), dermatitis (28 %), anemia (14 %) and vomiting (14 %) were the most pronouncing toxicities (grade 3 and 4) during CCRT. Conclusions : IC followed by CCRT treatment program is feasible, tolerable and safe. This strategy improved local control and distant disease control. However com-bined treatment program have failed to improve survival rates over the historical result of CCRT trials.