NEOADJUVANT CHEMOTHERAPY, EXTERNAL AND INTRACAVITARY RADIOTHERAPY IN NASOPHARYNGEAL CARCINOMA: ANALYSIS OF 19 CASES

Between August 1993 and August 1994, 19 patients with nasopharyngeal carcinoma (N2-3 or undifferentiated type) were treated with neoadjuvant chemotherapy (NCT), external beam radiotherapy (ERT) and Ir-192 high dose rate (HDR) intracavitary brachytherapy. NCT consisted 3 cycles of cyclophosphamide 500 mg/m2, epirubicin 70 mg/m2 cisplatin 100 mg/m2 which were administered at 3 week intervals. ERT was startad 3 weeks after the last chemotherapy cycle with a daily dose of 2 Gy. Sixty Gy was delivered to T1 -2 tumors and 70 Gy to T3-4; then 10 Gy electron boost was added to palpable lymph nodes. Intracavitary brachytherapy boost was given 1 week after the completion of ERT; 3 fractions of 5 Gy (15 Gy) were given to T1-2 tumors and 2 fractions of 5 Gy (10 Gy) to T3 tumors or to patients with T4 tumor who had residual mass seen in direct nasopharyngoscopy. After NCT, complete local response rate was 15.8% and partial response rate was 78.9%. Complete and partial regional response rates were 29.4% and 64.7% respectively. When local and regional responses were assessed together complete response rate was 5.3% and partial response rate was 89.4%. After radiotherapy was completed, tumor response rate and, nodal response rate rose to 94.7% and 88.2% respectively. Median follow-up time was 21 months (17-29 months). Four cases (21.1%) developed only regional, 3 cases (15.8%) developed both local and regional recurrences and 2 cases (10.6%) had distant metastasis. No life threatening grade IV acute or late toxicity was seen. The median disease-free survival time was 21 months (95% Cl 17-24 months), overall survival time was 24 months (95% Cl 23-26 months); 12-24 month disease-free and overall survival rates were 78.9%-48.2% and 94.7%-67.8% respectively.