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 followed 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 I) and cisplatin (80mg/m2 on day I) followed by concomitant conventionally fractionated radiation (70Gy in 2Gy fractions) and cisplatin 20-mg/m2/day on days 15, 22-26 and 43-47 of the radiation therapy. Results: Twenty nine patients (80%) and 32 patients (89%) achieved objective response after IC and concomitant chemo radiation (CCRT) respectively. The actuarial 3 years survival was 68%, and the actuarial 3 year progression free survival (PFS) was 66%. Survival and PFS were significantly better for patients with smaller tumor volume (stage III), compared with patients with stage IV. 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 recorded (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 combined treatment program have failed to improve survival rates over the historical result of CCRT trials