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A randomized trial on addition of concurrent-adjuvant chemotherapy and/or accelerated fractionation for locally-advanced nasopharyngeal carcinoma

2010; Elsevier BV; Volume: 98; Issue: 1 Linguagem: Inglês

10.1016/j.radonc.2010.09.023

1879-0887

Anne W.M. Lee, Stewart Y. Tung, Anthony T.�C. Chan, Rick Chappell, Yiu-tung Fu, Tai-Xiang Lu, Terence Tan, Daniel T. T. Chua, Brian O’Sullivan, Raymond Tung, Wai Tong Ng, To‐Wai Leung, Sing-Fai Leung, Stephen S.‐T. Yau, Chong Zhao, Eng-Huat Tan, Gordon K.�H. Au, Lillian L. Siu, Ka-kit Fung, Wai‐Hon Lau,

Lung Cancer Treatments and Mutations

Background and purposeTo evaluate the therapeutic benefits by adding chemotherapy (+C) and/or accelerated-fractionation (AF) for patients with T3-4N0-1M0 nasopharyngeal carcinoma.Materials and methodsFrom 1999 to 2004, 189 eligible patients were randomized to one of four treatment groups (CF/CF + C/AF/AF + C). The number of fractions/week was 5 for the CF groups and 6 for the AF groups. Patients in the +C groups were given concurrent cisplatin plus adjuvant cisplatin and fluorouracil.ResultsThe AF + C group achieved significantly higher failure-free rate (88% at 5-year) than the CF group (63%; p= 0.013), the AF group (56%; p= 0.001) and the CF + C group (65%; p= 0.027). As compared with CF alone, the increase in late toxicity was statistically insignificant (36% vs. 20%; p= 0.25). Deaths due to cancer progression decreased (7% vs. 33%; p= 0.011) but deaths due to incidental causes increased (9% vs. 2%; p= 0.62). Improvement in overall survival reached borderline significance (85% vs. 66%; p= 0.058).ConclusionsConcurrent-adjuvant chemotherapy combined with AF significantly reduced failure and cancer-specific deaths. Although the increase in major late toxicity and incidental deaths were statistically insignificant, a subtle increase in non-cancer deaths narrowed the overall survival gain.