Mature results of neoadjuvant chemotherapy followed by radiotherapy in nasopharyngeal cancer: is it really old fashioned?

Nasopharyngeal carcinoma (NPC) is known as a radiosensitive and chemosensitive tumor. The interest in neoadjuvant chemotherapy (NACT) has been refreshed in recent years due to promising results with more effective chemotherapeutic agents in head and neck tumors. The aim of this retrospective study is to evaluate the long-term toxicity and efficacy of NACT followed by radiotherapy (RT). From January 1995 to December 2002, 73 NPC patients were consecutively treated at Ege University Medical School Department of Radiation Oncology and the results were analyzed retrospectively. The NACT consisted of cisplatin 100 mg/m²/day and epirubicine 100 mg/m²/day, every 3 weeks. External radiotherapy by conventional fractionation was delivered 3 weeks after NACT. Response evaluated after NACT followed by radiotherapy showed 75% complete response (CR) rate. After a median follow-up time of 74 months, 32 relapses were noted. Most of the local failures were observed in 2 years (median 17 months) and the most common site for distant failure was bone. A total of 27 deaths had occurred due to uncontrolled disease. Xerostomia, soft tissue fibrosis and loss of sensorineural hearing were the most common long-term side effects. Only one treatment related death was observed and this patient died due to temporal lobe necrosis 22 months after the radiotherapy. The 5-year disease-free, distant metastasis-free and overall survival rates were 58, 77 and 68%, respectively. Current study showed that NACT with cisplatin and epirubicine followed by radiotherapy provided promising results with low toxicity in NPC patients.