ABSTRACT
Undifferentiated nasopharyngeal carcinoma is a chemosensitive lesion, but its role in the management of local advanced disease is under investigation. Twenty-seven untreated stage IV undifferentiated nasopharyngeal carcinoma patients were treated with radiotherapy (median dose, 66.6 Gy, 1.8 Gy/day) and concomitant cisplatin (100 mg/m2 days 1, 22 and 43). After 4 weeks, patients received, every 4 weeks, 3 cycles with cisplatin (80 mg/m2 day 1) + 5-fluorouracil (1,000 mg/m2/day continuous infusion for 96 h). After radiotherapy, we observed 74% complete responses and 26% partial responses; after adjuvant chemotherapy 96% had a complete and 4% a partial response. After a median follow-up of 36 months, 81% of the patients were alive (70% with no evidence of disease). Four-year overall and disease-free survival was 70% and 60%, respectively. Concomitant chemotherapy plus radiotherapy was well tolerated, whereas adjuvant chemotherapy was more toxic. Long-term results were significantly better than those observed with radiotherapy alone.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma/drug therapy , Carcinoma/radiotherapy , Cisplatin/therapeutic use , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/radiotherapy , Adult , Aged , Antineoplastic Agents/adverse effects , Carcinoma/pathology , Chemotherapy, Adjuvant/adverse effects , Cisplatin/adverse effects , Disease-Free Survival , Female , Humans , Male , Middle Aged , Nasopharyngeal Neoplasms/pathology , Neoplasm Staging , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , Survival Analysis , Treatment Failure , Treatment OutcomeABSTRACT
Combined radiation therapy and chemotherapy have been reported to produce a high incidence of complete regression of epithelial cancer of the anal canal. Our group has treated 25 patients since June 1986. Treatment included chemotherapy (first period: Mitomycin C + 5-Fluorouracil; second period: Carboplatin + 5-Fluorouracil) and simultaneous whole-pelvis irradiation (50.40 Gy). Our results confirm that radiochemotherapy can achieve good local control: all patients were in complete clinical remission three months after the completion of combined therapy. Seven, patients developed recurrences; the actuarial survival rate was 78.5% and the disease free survival rate 67%. Acute toxicity was tolerable, but a relatively high number of patients exhibited chronic treatment-related symptoms. In order to reduce late side effects, other studies are necessary to explore if, in patients with small tumors, less extensive locoregional treatment can be effective without reducing the survival rate.
