Abstract 1984
Background
Current treatment of locoregionally advanced NPC (LRA-NPC) is CCRT with or without adjuvant chemotherapy (CT). The value of adding IC to CCRT in LRA-NPC is unclear. We retrospectively evaluated LRA-NPC patients treated with IC followed by CCRT in a single tertiary center in Turkey.
Methods
Between 2004 and 2016, 202 patients with nonmetastatic LRA-NPC (stage 3-4), 144 males and 58 females ranging from 17 to 75 (median 49) years old, were treated with IC followed by CCRT. Eleven (%5.4) patients had keratinised (WHO I), and 191 (%94.6) had nonkeratinised or undiffrentiated (WHO II-III) carcinoma. Cumulative radiation dose to primary tumor ranged from 60 to 74 (median 70) Gy. Ninety-one (%45) of the patients received 2-dimensional and 111 (%55) received intensity modulated radiotherapy (IMRT). IC consisted of taxane (T)(75 mg/ m2) and platinum (P)(75 mg/m2) combination (199 patients) or P and fluorouracil or epirubicine (3 patients) combination and 188 of the patients received 3 cycles of IC. Concomittant P was used either weekly (40 mg/m2, 25 patients) or every 3-weekly (100 mg/m2, 177 patients) application. Follow-up ranged from 5 to 167 months (median, 72.5 months).Table: 1143P
Patient and treatment characteristics | n ( % ) |
---|---|
Stage | |
III IVA IVB | 149 (73.7%) 30 (14.9%) 23 (11.4%) |
Number of induction courses | |
2 3 4 | 10 (5%) 188 (93.1%) 4 (2%) |
Concomittant type | |
Every 3 weeks (100 mg/m2) Every week (40 mg/m2) | 177 (87.6%) 25 (12.4%) |
RT technique | |
2-dimensional Intensity modulated | 91 (45%) 111 (55%) |
Radiation dose to primary (Gy) | |
≤ 70 > 70 | 8 (4%) 194 (96%) |
Results
Treatment failure was observed in 52 (%25.7) of the patients (21 local, 13 regional and 27 distant). Distant failure rate of all the patients exceeds 13%. Five and 10 years disease free survival (DFS) rates are 75.2% and 70.4% and overall survival (OS) rates are 78.9% and 64% respectively. In univariate analysis patient age favoring those below 49 and stage of disease favoring WHO II-III were all significant predictors of DFS and OS. In addition pathology was a significant predictor of DFS.
Conclusions
LRA-NPC patients treated with IC followed by CCRT have a high locoregional control (LRC) rate. Despite the use of IC distant control remains insufficient and continues to be a challenge in NPC. Besides improving LRC, more effective systemic therapy is needed.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Musa Altun, MD.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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