RESUMO
Background: The standard treatment of patients with advanced nasopharyngeal carcinoma is concurrent chemoradiotherapy followed by chemotherapy. The voluminous number of patients with this disease and the constraints of limited facilities to accommodate such number of patients in our institution have brought about treatment modifications. This pilot study compared the 3-year progression-free survival (PFS) and overall survival (OS) of patients with advanced nasopharyngeal cancer who received concurrent chemoradiotherapy as induct ion fol lowed by chemotherapy ver sus chemotherapy fol lowed by concurrent chemoradiotherapy. Patients and Methods: From 2005 to 2007, 30 patients with biopsy-proven stage III to IV-B nasopharyngeal cancer seen at the Medical Oncology Outpatient/Inpatient unit of the Philippine General Hospital were randomized to receive cisplatin (25 mg/m2 D1-4) on weeks 1, 4 and 7 of radiotherapy (70 Gy for 7 weeks) followed by cisplatin (20 mg/m2 D1-4) and 5-fluorouracil (1000 mg/m2 D1-4) on weeks 11, 15 and 19 (standard arm) or to receive cisplatin (20 mg/m2) on D1-4 and 5-fluorouracil (1000 mg/ m2 on D1-4) on weeks 1, 5 and 9 followed by concurrent chemoradiotherapy. started after 4 weeks of the 3rd cycle of chemotherapy (week 13) with cisplatin (25 mg/ m2 on D1-4) given on weeks 13, 16 and 19 of treatment every 3 weeks dur ing radiotherapy (investigative arm).Treatment modifications were done based on creatinine clearance and toxicities. Carboplatin (AUC 5) was substituted for cisplatin for creatinine clearance < 30 ml/min or grade 3 hearing impairment. Results: Baseline characteristics were comparable except for age and histology. Median PFS was 19.6 months (standard arm) versus 25.7 months (investigative arm). 3-year PFS rates were 25% and 63%, respectively with hazard ratio 2.64 (p= 0.176). Median OS were 17.5 months and 21.5 months, respectively. 3-year survival rates were 36% and 25.4%, respectively with hazard ratio 0.92 (p= 0.889). The complete response rate was 18.7% (standard arm) versus 28.5% (investigative arm), partial response rate was 31.2% vs 21.4% and progressive disease was 31.2% and 28.5% respectively. Anemia, anorexia, nausea, vomiting and xerostomia were the most frequent grade 3 adverse events. Conclusion: Induct ion chemotherapy fol lowed by concur rent chemoradiotherapy appears to be comparable to the standard of concurrent chemoradiotherapy followed by chemotherapy in terms of PFS and OS. However, no final conclusion can be drawn due to the small sample size and poor follow-up.