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A concurrent chemoirradiation with cisplatin followed by adjuvant chemotherapy with ifosfamide, 5-fluorouracil, and leucovorin for stage IV nasopharyngeal carcinoma.
Chua, Daniel T T; Sham, Jonathan S T; Au, Gordon K H.
Affiliation
  • Chua DT; Department of Clinical Oncology, PB 115, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China. dttchua@hkucc.hku.hk
Head Neck ; 26(2): 118-26, 2004 Feb.
Article in En | MEDLINE | ID: mdl-14762880
BACKGROUND: To evaluate the toxicity and efficacy of concurrent chemoirradiation with cisplatin followed by adjuvant ifosfamide, 5-fluorouracil and leucovorin in patients with stage IVb nasopharyngeal carcinoma (NPC) PATIENTS AND METHODS: Between October 1998 and August 2001, 35 Chinese patients with stage IVb NPC (N3a:12, N3b:23) were treated with by concurrent chemoirradiation using cisplatin 100 mg/m2 on days 1, 22, and 43 of radiotherapy, followed by adjuvant chemotherapy with 1.4 g/m2, ifosfamide, 450 mg/m2 5-fluorouracil, and 20 mg/m2 leucovorin daily for 5 days and repeated every 3 weeks for three cycles. Radiotherapy was given using standard fractionation at 2 Gy/day to a total of 68 Gy to the nasopharynx and 66 Gy to the neck. RESULTS: All patients completed the prescribed radiotherapy. Twenty-three patients (66%) completed all scheduled cycles of chemotherapy. The compliance rate for concurrent and adjuvant chemotherapy was 71% and 80%, respectively. Grade 3 mucositis occurred in 37%, and grade 3 dermatitis occurred in 11.5% during radiotherapy. Grade 3 neutropenia occurred in 17% during concurrent chemotherapy, and grade 3-4 neutropenia occurred in 48.5% during adjuvant chemotherapy. There were no treatment-related deaths. With a median follow-up of 31 months, the 3-year relapse-free rate was 60%, and the 3-year overall survival rate was 74%. Locoregional control was excellent, with a 3-year local and nodal relapse-free rate of 91% and 83%, respectively. Eleven patients (31%) had developed distant metastases, and the 3-year distant metastasis-free rate was 66%. CONCLUSIONS: The chemotherapy regimen tested is practical with an acceptable compliance rate. Despite having a more advanced stage disease, the observed outcome of our patients seems to be comparable with other series using platinum-based adjuvant chemotherapy. Further investigation to confirm the benefit of using the study regimen in advanced stage NPC is warranted.
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Database: MEDLINE Main subject: Carcinoma / Antineoplastic Combined Chemotherapy Protocols / Nasopharyngeal Neoplasms / Ifosfamide Type of study: Clinical_trials / Etiology_studies Language: En Journal: Head Neck Year: 2004 Type: Article Affiliation country: China
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Database: MEDLINE Main subject: Carcinoma / Antineoplastic Combined Chemotherapy Protocols / Nasopharyngeal Neoplasms / Ifosfamide Type of study: Clinical_trials / Etiology_studies Language: En Journal: Head Neck Year: 2004 Type: Article Affiliation country: China