Clinical outcomes in patients with locally advanced nasopharyngeal cancer treated with neoadjuvant docetaxel and cisplatin followed by radiation treatment and concomitant cisplatin

Abstract

Clinical outcomes in patients with locally advanced nasopharyngeal cancer treated with neoadjuvant docetaxel and cisplatin followed by radiation treatment and concomitant cisplatin.e16017Background:Radiation treatment with concomitant chemotherapy has improved the therapeutic outcome of patients with locally advanced nasopharyngeal carcinoma. However, the importance of neoadjuvant chemotherapy before the definitive therapy is still undefined. We report the results of our experience with neoadjuvant chemotherapy.Methods:Between 2004 and 2008, charts of 59 patients with advanced loco regional nasopharyngeal carcinoma treated in our institute were reviewed. They received induction chemotherapy consisting of cisplatin (75mg/m2) on day 1 and docetaxel (75mg/m2) on day 1 every 3 weeks and followed by definitive radiotherapy and concomitant cisplatin (100mg/m2) every 3 weeks or (40mg/m2) weekly during the radiotherapy.Results:The median age was 49 years 18-68y) and median follow up was 29 months (6-56mo). According to the American Joint Committee on Cancer's 2002 stage classification, all patients were stage II (15%), stage III (63%) and stage IV (22%). Fifty eight patients received 3 cycles of chemotherapy. One patient could not take the full dose chemotherapy due to gastrointestinal toxicity. Except for this patient, there was no grade 3 or 4 toxicity after induction chemotherapy. Concomitant cisplatin with radiation therapy was given to forty nine patients (83%). Of those, thirty two patients received more than 1 cycle of concomitant cisplatin. Grade 3 and/or 4 toxicities after cheomoradiation therapy were mucositis (46%), weight loss (10%), skin toxicity (14%), esophagitis (5%), emesis (5%), neutopenia (5%), thrombocytopenia (3%) and anemia (2%). Fifty one patients (87%) and fifty six (95%) patients achieved an objective response (Complete and partial response) after induction chemotherapy and chemoradiotherapy, respectively. One patient had local relapse alone, 2 patients had both local and distant metastases and 4 patients had distant metastases. Three years overall survival (OS) and disease free survival (DFS) rates were 93% and 83%, respectively.Conclusions:Induction chemotherapy with docetaxel and cisplatin is a feasible and tolerable treatment.