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Induction Chemotherapy Prior To Radiotherapy Offers A Better Five-Year Survival In Advanced Nasopharyngeal Carcinoma

The combination of induction therapy and radiotherapy for patients with advanced nasopharyngeal carcinoma, grade three, offers a good five-year survival rate.

Researchers administered mitomycin-containing cisplatin-based induction chemotherapy but suggest that further investigations are necessary to incorporate concurrent chemotherapy.

Distant metastases compromise survival for patients with advanced nasopharyngeal carcinoma (NPC). Mitomycin is active against hypoxic and GO cells. Consequently, clinicians from the National Taiwan University Hospital in Taipei investigated the possible role in helping to eradicate micrometastases of mitomycin, epirubicin, cisplatin, fluorouacil and leucovorin.

Participants included 111 patients who were recruited from the American Joint Committee on Cancer (AJCC) 1992 staging system 1V between January 1994 and December 1997. Their adverse features included obvious intracranial invasion, supraclavicular or bilateral neck lymph node metastasis, large neck node of more than 6 cm, or elevated serum lactate dehydrogenase (LDH) level. All were given chemotherapy comprising a three-week cycle of mitomycin, epirubicin and cisplatin on day one and fluorouracil and leucovorin on day eight (MEPFL) prior to radiotherapy.

The patients were followed up for a median period of 43 months. The five-year overall survival rate was 70 percent (95 percent confidence interval [CI] 60 percent to 80 percent n =111). The five-year locoregional control rate was 70 percent in the 100 patients who had completed radiotherapy (95 percent CI, 55 percent to 84 percent) and the distant metastases- free rate was 81 percent (95 percent CI, 73 percent to 89 percent).

The five-year distant metastasis-free rate of N3a and N3b disease of AJCC 1997 staging system were 79 percent (95 percent CI, 62 percent to 95 percent) and 74 percent (95 percent CI, 60 percent to 89 percent) respectively.

Using Cox multivariate analysis, the high serum LDH level and neck nodal enlargement prior to radiotherapy proved adverse prognostic factors of survival.
JCO December 2001 Vol 19 No 23 pp 4305-4311. "Induction Chemotherapy With Mitomycin, Epirubicin, Cisplatin, Fluorouracil, and Leucovorin Followed by Radiotherapy in the Treatment of Locoregionally Advanced Nasopharyngeal Carcinoma"

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