A Phase Ⅲ Study Of Induction Chemotherapy And Radiotherapy Concomitant HCFU Chemotherapy In Local Advanced Nasopharyngeal Carcinoma

Advanced nasopharyngeal carcinoma (NPC) barbers a higher metastatic and locoregional recurrent potential. To study the impact on the locoregional control and metastasis and acute toxicity in patients with nasopharyngeal carcinoma (NPC) who were treated with 2 cycles of induction chemotherapy(ICT) followed radical radiotherapy alone(RT) and radiotherapy concomitant HCFU chemotherapy (RTCHC). METHODS AND MATERIALSsixty-six newly diagnosed patients with Stage III and IV (Fu Zhou, 1992) NPC were recruited onto two randomized tials,namely ,thirty-three patients for RT,and others for RTCHC, they were treated with 2 cycles ICT followed RT and RTCHC. Two cycles of ICT, eachconsisting of IFO, 1.2g/m(2) on Days 1-3,5-fluorouracil, 0.5 g/m(2)/d on Days 1-5 and cisplatin 80 mg/m(2) on Day 1 or 20 mg/m(2) on Days 1-5 , were administered ,followed RT and RTCHC. The nasopharyngeal tumor dose was 70 Gy delivered in 35 fractions, the cervical nodal metastasis dose 60-70Gy delivered in 30-35 fractions, 5 fractions weekly,the tumor residua was added about lOGy. HCFU was taken orally 200mg t.i.d. in the course of radiotherapy for RTCHC. RESULTSAfter two circles of induction chemotherapy,the overall respose rate of nasopharyngeal tumor and cervical nodal disease were 84.8% and 89.1%,respectively; the complete respose rate of nasopharyngeal tumor and cervical nodal disease were 4.5% and 12.7%,respectively, and the partial respose of that was 80.3%and 76.4%,respectively. The average complete respose dose of nasopharyngeal tumor for RT and RTCHC was 67.0303 + 8.9039 Gy , 59.1515 + 8.1399 Gy ( P<0.01 Respectively ( P=0.036 ) , that of cervical nodal disease was 60 +8.9443 Gy. 49.037 + 9.4359 Gy, respectively (P<0. 001). The average radicaldose of nasopharyngeal tumor for RT and RTCHC was 74. 3636 +5.0856 Gy and 72.0303 + 3.627Gy, respectively ( P=0. 036 ) ; that of cervical nodal disease was 68 + 6.0133 Gy and 63. 4818 +4.458IGy, respectively( P=0. 003 ). After three months of radiotherapy, the complete respose rate of 90.9% of nasopharyngeal tumor for RTCHC was more than that of 66.7% for RT (p=0.016), and that of 92.6% of cervical nodal disease for RTCHC was more than that of 71.4% for RT (p=0.042).After a median follow-up of 10 months, the locoregional recurrent rates of 3% of the nasopharyngx for RTCHC was less than that of 15.2% for RT (p=0.087) ,and that of 3.7% of the neck for RTCHC was less than that of 14.3% for RT (p=0.163) ; The system metastasis rate of 15.2% for RT was more than that of 6.1% for RTCHC(p=0.230); The survival rates for RT and RTCHC were not significative .Adverse effects such as leukopenia, mucositis,nausea,dermatitis and so on,were observed in treated patients ,other adverse effects such as hot sensation , pollakisuria and dizziness, were done in 36.4%,45.5%and 9.1% of patients treated by HCFU,respectively.CONCLUSIONInduction chemotherapy followed radiotherapy concomitant HCFU chemotherapy was effective in our patients with local advanced NPC,reducing the dose of the complete repose and the radical dose in the nasopharyngeal tumor and cervical nodal metastasis . The locoregional control and system metastasis appear encouraging.Although the acute toxicity in those patients received RTCHC was aggravated,but they were able to endure . This single institution experience deserves further investigation in prospective trials.