Control of regional metastasis after induction chemotherapy and radiotherapy for nasopharyngeal carcinoma

Head Neck. 2002 Apr;24(4):350-60. doi: 10.1002/hed.10056.


Background: To study the impact of adding induction chemotherapy to radiotherapy on the long-term control of regional metastasis and survival in patients with nasopharyngeal carcinoma (NPC).

Methods: Between February 1988 and August 1993, 240 NPC patients with Ho's T3 stage, N2-3 stage, or nodal size >/=3 cm were recruited onto two randomized trials comparing induction chemotherapy followed by radiotherapy (CT + RT) and radiotherapy alone (RT) using a similar treatment protocol. Of these, 210 patients (105 in each treatment arm) had cervical nodal metastasis and were included in the analysis. Patients in the CT + RT arm received two to three cycles of cisplatin, 60 mg/m(2) day 1, + epirubicin, 110 mg/m(2) day 1, followed by radiotherapy. Radiotherapy technique and dose were similar in both arms. The median follow-up time was 71 months (range, 5-152 months).

Results: The overall response rate of nodal disease to chemotherapy was 86%, and the complete response (CR) rate was 44%. At the end of radiotherapy, 92% of patients in the CT + RT arm and 86% in the RT arm achieved CR in the neck (p =.12). The 5-year nodal relapse-free survival rates in the CT + RT and RT arm were 83% and 75%, respectively (p =.13). Most neck failures (81%) occurred during the first 36 months of follow-up. Radical neck dissection successfully salvaged 41% of neck failures in the CT + RT arm and 46% in the RT arm. The 5-year distant metastases-free survival rates were 70% in the CT + RT arm and 68% in the RT arm (p =.56), and the corresponding 5-year disease-specific survival rates were 66% and 68%, respectively (p =.55). In subgroup analysis, no significant differences in regional control and survival could be found in patients with Ho's N2-3 stage, AJCC N2-3 stage, or nodal size >6 cm.

Conclusions: Induction chemotherapy does not seem to improve the regional control and survival in NPC patients with regional metastasis compared with radiotherapy alone and is not recommended as a routine treatment outside the context of a clinical trial.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoma / drug therapy*
  • Carcinoma / pathology
  • Carcinoma / radiotherapy*
  • Carcinoma / secondary
  • Combined Modality Therapy
  • Female
  • Humans
  • Lymphatic Metastasis / prevention & control
  • Male
  • Middle Aged
  • Nasopharyngeal Neoplasms / drug therapy*
  • Nasopharyngeal Neoplasms / mortality
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Prospective Studies
  • Remission Induction
  • Survival Analysis
  • Treatment Outcome