Improved outcome secondary to concurrent chemoradiotherapy for advanced carcinoma of the nasopharynx: Preliminary corroboration of the intergroup experience

Purpose: The recent Intergroup 0099 trial of concurrent chemoradiotherapy for advanced nasopharyngeal carcinomas, demonstrated improved survival for chemoradiotherapy as compared to radiation therapy alone. Following closure of this study, we adopted the chemoradiotherapy regimen used in 0099 as our standard of practice. We herein report our recent institutional results, representing a relatively large uniformly treated cohort. Methods and Materials: Between 1995 and 1997, 35 consecutive patients, who had clinically nondisseminated Stage III or IV nasopharyngeal cancer, were treated by chemoradiotherapy. The prescribed radiation regimen was 7000 cGy delivered in 35 fractions over 7 weeks to all macroscopic disease and 5000 cGy to areas considered at risk of harboring microscopic disease. Chemotherapy was designed to deliver cisplatin (100 mg/m(2) i.v.) on Days 1, 22, and 43 of radiation therapy and cisplatin (80 mg/m(2) i.v.) on Days 71, 99, and 127 plus flurouracil (5-FU; 1 g/m(2)/day by 96-h infusion) on Days 71-74, 99-102, and 127-130. Results: All patients had at least a partial response (PR) to treatment, including an 85% complete response (CR) rate, The actuarial 3-year overall survival rate was 93% and the disease-free survival rate was 65%. Both represent substantial improvements over our institutional historical controls treated by radiation therapy alone and both are similar to the rates observed in the Intergroup trial. Conclusion: Our data support the conclusion that concurrent chemoradiotherapy followed by adjuvant chemotherapy (as was used in Intergroup 0099) should be considered the current standard of care for patients who have advanced cancers of the nasopharynx, (C) 2000 Elsevier Science Inc.