Study Of Induction Chemotherapy Plus Concurrent Chemoradiotherapy Versus Radiotherapy Alone In Paients With Locoregionally Advanced Nasopharyngeal Carcinoma

BACKGROUND&OBJECTIVEDocetaxel(TXT) and cisplatin(DDP) are effective drugs for head and neck tumors.Stage II-ⅣA clinical trial of TP regimen (docetaxel combined DDP) for head and neck tumors has completed. Have reported in the literature, Induction chemotherapy combined with RT can significantly decreases incidence of distant metastases; Concurrent chemotherapy can improve the local regional control and OS. For induction chemotherapy combined chemoradiotherapy research have fewer reported. This study was to compare the efficacy and toxicity of TP scheme induction chemotherapy combined concurrent chemoradiotherapy and radiotherapy alone in treating advanced nasopharyngeal carcinoma (Ⅱ-ⅣA stage,T2-4N0-1,1992, Fuzhou staging),to explore the feasibility of the model of clinical treatment.METHODS AND MATERIALSEighty-four NPC patients treated in GuangZhou medical college affiliated hospital of tumor between March.1,2007 and August.20,2008 were recruited onto two randomized groups,forty-two patients for CCRT as study group,and others for RT alone as control group. Before radical radiotherapy,the study group patients received 2 cycles of induction chemotherapy with TP regimen, cisplatin﹙DDP﹚20mg/m2 on Day 1-4 and Docetaxel(TXT)60mg/m2 on Day 1, Chemotherapy once every three weeks. During the same period for RT,two cycles of the TP scheme were achieved. The control group only received the radiotherapy alone. Two groups of patients received the same radiotherapy of CT simulation.The nasopharyngeal tumor dose was 70Gy delivered in 35 fractions,the cervical nodal metastasis dose 60-70Gy delivered in 30-35 fractions, 5 fractions weekly,the tumor residua was added about 10Gy. RESULTSAfter two circles of induction chemotherapy,the overall respose of nasopharyngeal tumor and cervical nodal disease in study group were high,34 achieved partial remission(PR) and 8 had stable disease (SD) for nasophatyngeal lesions,6 achieved complete remission (CR),22 achieved PR for regional lymph nodes.After concurrent chemoradiotherapy, in study group there were 37 achieved CR for nasopharyngeal lesions and 5 achieved PR; 24 achieved CR and 4 achieved PR for regional lymph nodes. In the control group,there were 29 patients achieved CR and 13 achieved PR for nasopharyngeal lesions; 20 achieved CR and 7 achieved PR for regional lymph nodes after radical radiotherapy.There were statistical significant difference in nasophatyngeal lesions on complete remission(CR) between the two groups,(P<0.05). After 3 months radiotherapy, There were statistical significant difference in nasophatyngeal lesions and regional lymph nodes on complete remission(CR) (P<0.05). During the follow-up period,Distant metastasis is lower in study group than control group.There were statistical significant difference between the two groups(P<0.05). Local control rate was similar in both groups.In Toxicity reaction,the occurrence rates of bone marrow suppression(especially the occurrence rates of grade 3-4 neutropenia),nauseation,vomit and atrichia,but no effect the treatment.The difference between the two groups was statistically significant.But these can be tolerable by using G-CSF.The two groups in skin and oral mucosa inflammatory reaction were similar. CONCLUSIONTP scheme induction chemotherapy plus chemoradiation treatment for local middle-late nasopharyngeal carcinoma had improved the local control and reduced the 1 year distant metastasis,the adverse events are tolerable,but the long-term outcomes and toxicities need to be further investigated.