Induction Chemotherapy with Docetaxel, Cisplatin and 5 Flurouracil Followed by Concurrent Chemoradiation Therapy in Locally Advanced Nasopaharyngeal Carcinoma
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- Category: Vol. 81, September 2013
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Induction Chemotherapy with Docetaxel, Cisplatin and 5 Flurouracil Followed by Concurrent Chemoradiation Therapy in Locally Advanced Nasopaharyngeal Carcinoma,WAEL ELSADDA,
MOHAMED EL-ASHRY and ESSAM EL-SHERBEINY
Abstract
Background: Nasopharyngeal carcinoma (NPC) is the most common head and neck carcinoma in Egypt. The standard treatment of locally advanced carcinoma of the nasopharynx is cisplatin based chemotherapy followed by locoregional radiotherapy. Taxotere in combination with the standard cisplatin-5-FU as neoadjuvant for patients with locally ad-vanced NPC had increased the overall response rate and prolonged the overall survival with a predictable, reversible and manageable toxicity. The aim of the study is to evaluate the efficacy, tolerability and toxicity of induction chemotherapy with docetaxel, cisplatin and 5-FU (TPF) followed by concur-rent cisplatin and RT in patients with locally advanced NPC.
Patients and Methods: Thirty patients with histologically proven Sq.C.C. of the nasopharynx, stage III and IV without evidence of distant metastasis were enrolled in the study between December 2007 and December 2009. WHO PS 0 and 1 with adequate bone marrow, renal and liver function. All patients were treated with three cycles of induction chemo-therapy including docetaxel 75mg/m2 IV over 1 h on D1, cisplatin 75mg/m2 IV infusion over 3h D1 and 5-FU 750mg/ m2/d IV continuous infusion over 24h from D1 to D5, this cycle was repeated every 3 weeks. All patients received systematically premedication with corticosteroids before and after docetaxel, hydration regimen before and after cisplatin, prophylactic antibiotic therapy for 10 days on day 5 and G-CSF on day 6 of 5-FU. Radiation was delivered using con-ventional fractionation (2Gy/d, 5 fractions/week, a total dose of 70Gy) with concurrent weekly cisplatin 40mg/m2 IV infusion. Response was assessed by physical examination, nasopharyngoscopy, CT scan after cycle 2 of chemotherapy, after completion of chemotherapy and 6-12 weeks after completion of CRT.
Results: All patients had completed the scheduled treatment were evaluable for response, toxicity, and survival. The median age was 44.5 years (range 27-62 years), the male to female ratio was 2:1 (20 males & 10 females). Twenty patients (66.7%) were stage III and 23.3% were stage IV, twenty one patients (70%) had PS 0, 21 patients (60%) had cervical lymph node involvement (N1, N2). The overall response rate after induction chemotherapy was (80%), (CR 13.3%, PR 66.7%), stable disease (20%). The overall response rate after CRT was 90% (CR 66.7%, PR 23.3%) and stable disease (10%). No WHO G4 toxicities were noted, 3 patients (10%) had G2 anemia, and four patients (12%) had G3 neutropenia. Alopecia & diarrhea of G1 were observed in all patients, G2 mucositis in 18 patients (60%). Weight loss was observed in all patients with a median loss of 5kg. The 3-years disease free survival was 83.3% and the overall survival 86.7%.
Conclusion: Induction chemotherapy using TPF followed by concurrent CRT in locally advanced NPC is a safe, tolerable, effective protocol with a high ORR 90%.