Clinical study of induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil followed by radiotherapy and concurrent cisplatin in local advanced nasopharyngeal carcinoma / 肿瘤研究与临床

ABSTRACT

Objective To assess the efficacy and feasibility of neoadjuvant therapy of TPF regimen including docetaxel (TAX), cisplatin (DDP) and 5-fluorouracil (5-Fu) combined with concurrent DDP and radiotherapy (RT) in patients with local advanced nasopharyngeal carcinoma (NPC). Methods From April 2008 to May 2009, 40 patients with newly diagnosed UICC stage Ⅲ orⅣ local advanced NPC were enrolled. Patients were randomly assigned to group A(DDP every 3 weeks) and group B(DDP every week). Two cycles of induction chemotherapy with TAX 60 mg/m2 dl, DDP 60 mg/m3 dl and 5-Fu 600 mg/m2 dl-5 were given on a 3-weekly cycle, followed by RT and chemotherapy(group A DDP 80 mg/m2 every 3 weeks for 2 times; group B DDP 30 mg/m2 weekly for 6 times). Two-dimension conformal RT technique with 68-72 Gy/(34-36) fractions for 7 weeks was administered to the nasopharynx and 60-66 Gy/(30-33) fractions for 6-6.5 weeks to the node-positive area. Results 38 patients (78 Cycles) were evaluable for efficacy and toxicity. One patient in each group was excluded due to toxicity. 17 (17/19) patients of group A finished 2 cycles of planed DDP chemotherapy, while only 10 (10/19) patients of group B completed 6 weeks of planed DDP chemotherapy, 4 completed 5 weeks, 4 completed 4 weeks and 1 completed 2 weeks. Response to neoadjuvant TPF was as follows 4 patients (10.5 %) achieved complete response(CR), 27(71.1%) achieved partial response(PR) and 7 (18.4 %) achieved stable disease (SD), so the overall response (CR+PR) rate was 81.6 %. After RT, 32 patients (84.2 %) achieved CR, 5 (13.2 %) PR and 1 (2.6 %) SD, so the overall response rate was 97.4 %. Conclusion TPF induction chemotherapy followed by concurrent DDP and RT is an effective regimen in the treatment of advanced NPC. Concurrent DDP chemotherapy on a 3-weekly cycle is recommended. Further study should be made to investigate how to increase the dose intensity of chemotherapy.