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Concurrent and Adjuvant Chemotherapy for Nasopharyngeal Carcinoma: A Factorial Study

From the Department of Clinical Oncology, the University of Hong Kong, Queen Mary Hospital, Hong Kong

Address reprint requests to Jonathan Sham, MD, Department of Clinical Oncology, the University of Hong Kong, 1/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong; e-mail: jstsham{at}ha.org.hk

PURPOSE: To study the efficacy of concurrent chemoradiotherapy (CRT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS: Patients with Ho's stage T3 or N2/N3 NPC or neck node 4 cm were eligible. Patients were randomly assigned to have radiotherapy (RT) or CRT with uracil and tegafur and to have AC or no AC after RT/CRT. AC comprised alternating cisplatin, fluorouracil, vincristine, bleomycin, and methotrexate for six cycles. There were four treatment groups: A, RT; B, CRT; C, RT and AC; D, CRT and AC. For CRT versus RT, groups B and D were compared with groups A and C. For AC versus no AC, groups C and D were compared with groups A and B.

RESULTS: Three-year failure-free survival (FFS) and overall survival (OS) for CRT versus RT were 69.3% versus 57.8% and 86.5% versus 76.8%, respectively (P = .14 and .06; n = 110 v 109). Distant metastases rate (DMR) was significantly reduced with CRT (14.8% v 29.4%; P = .026). Locoregional failure rates (LRFR) were similar (20% v 27.6%; P = .39). Three-year FFS and OS for AC versus no AC were 62.5% versus 65% and 80.4% versus 83.1%, respectively (P = .83 and .69; n = 111 v 108). DMR and LRFR were not reduced with AC (P = .34 and .15, respectively). Cox model showed CRT to be a favorable prognostic factor for OS (hazard ratio, 0.42; P = .009).

CONCLUSION: An improvement in OS with CRT was observed but did not achieve statistical significance. The improvement seemed to be associated with a significant reduction in DMR. AC did not improve outcome.

This study was supported by grants from the University of Hong Kong (Committee on Research and Conference Grants grant No. 21600/301/01, 21600/323/01, 337/037/0001), the Li Ka Shing Foundation, the Hong Kong Jockey Club (Charity) Ltd, the Ho Hung Chiu Foundation, and Croucher Foundation, Hong Kong.

Presented in part at the Forty-Third Annual Meeting of the American Society for Therapeutic Radiology and Oncology, San Francisco, CA, November 4-8, 2001, and the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 31 to June 3, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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