Comparison of Concurrent Chemoradiotherapy versus Induction Chemotherapy Followed by Radiation in Patients with Nasopharyngeal Carcinoma MASANORI KOMATSU!, MAMORU TSUKUDA!, HIDEKI MATSUDA! CHOICH! HORIUCH! ‘TAKAMIDE TAGUCH!, MASAHIRO TAKAHASHI, GOHSHI NISHIMURA, MAKIKO MORI! ‘TATUO NIHO!, JUNICHT ISHITOYA?, YASUNORI SAKUMA?, MARIKO HIRAMA? and OSAMU SHIONO” ‘Department of Otolaryngology, and Heud and Neck Surgery. Yokohama City University School of Medicine. Kanazawa-Ku. Yokohama, Japan: 2Departmeat of Otolaryngology, Yokohama City University Medical Ceater, Minami-Ku, Yokohama, Japan Abstaet. Purpose: The study aimed evaluate the fficecy of concurrent chemoradioheropy (CCRT) with platiaun- hosed chemotherapy as a primary treament for nsopharyngeal carcinoma (NPC) ard to frtner compare the results of CCRT with these of neoadjuvant chemotherapy (NAC) followed by radiotherapy (RT). Paiens and Methods: Before 1988.21 patent with NPC received NAC followed by ET (NAC-RT). Between 1999 and 2008, a tual of 25 NPC patients received CCRT. The CCRT group received a regimen Including docetae! (50 rsfn2, day), cisplatin (CDDP. 60 ‘main day4) and continuous Sfluorouracl (5-FU) infusion (600 imgln2, day 15), the TPF repimen, or a regimen including CDDP (6) meln?, day), continuous 5-FU infusion (600 mgind, day 15), mthotrexae (MTX, 30 mein, day 1) ‘an teucovorin (LY, 20 mgint, day 1-5), PFML regimen. The CCRT group received 2 cycles of chemesherapy daring definve RT. The NAC group of patients received a PFML regimen. Results: The overall response rate afier CCRT was 96%. The 3-year and 5-year disease-specific survival rates were 75.0% and 60.1%, respectively. In patients receiving [NAC-RT, the 3-year and 5-year disease-specific survival rates were 84.1% and 67 3%, respectively. There was no difeence observed in terme of survival rates between the group receiving CCRT and that receiving NAC-RT. Conetusion: CCRT withthe TPF or PFML regimen was tolerable, and the NPC patients receiving this weanment showed ccellent survive cates. comparison to the group receiving NACI, (CCRT had no advantage in terms ofthe survival rae. In the fusce, the contol of distant metastasis might play an ‘important role in improving the survival rate of patients with ‘advanced NPC receiving CCRT. Nasopharyngeal carcinoma (NPC) is an extremely rare cancer in Japan, NPC is considered unresectable because of uae anatomical location, and raliotherapy (RT) is the standard tweatment modality. NPC is considered to be aot only radiosensitive but also chemosensiive. On the basis of these charncteistis, several randomized tials using RT plas chemorherepy for treating NFC have been conducted (1-8). The reais of these = triale showed that concurrent chemoradiottrapy (CCRT) either with cx witout maintenance chemotherapy is considered more effective than RT alone. ‘Currently, chemotherapy regimens that include cisplain (CDDP) and 5-Aluorouracl(5-FU) (PF) are considered to be the standard teatment for patients with squamous cell carcinoma of the hea and neck (HNSCC). Since 1995, we hhave been developing a multiagent chemotherapy for locoregionally advanced HNNSCC. this regimen consists of DF with methotrexate (MTX) and leucovorin (LV) (PFML) (9-11), PFML was initially used in the neoadjuvant chemotherapy (NAC) setting study. Since the end of 1998, PEML has boca employed as chemotherapy in CORT for aDot pie doorg/10-7314IAPICP2014.15 2809 Gemetabine And Cisplatin Followed By Chemo-Rochation In Advanced Nasepharyngent Carcinoma RESEARCH ARTICLE Gemcitabine And Cisplatin Followed by Chemo-Radiation for Advanced Nasopharyngeal Carcinoma Arif Jamshed', Raza Hussain’, Hassan Iqbal™* Abstract Concurrent cheme-radiation (CRT) has been established asthe standard of care for nomametastatc loco regionally advanced nasopharyngeal carcinoma (NPC) but recently the addition of induction chemotherapy i the already established regimen has presented an attractive multidisciplinary approach. Thisretrospective study ‘was carried out to evaluate the efficacy of induction chemotherapy (IC) followed by CRT for the management of loco-regionally advanced NPC. Between July 2005 and September 2010, 99 patients were treated with cisplatin based IC followed by CRT. Induction chemotherapy inchaded « 2 drug combinations intravenous gemcitabine 1000 mg/zn? om day 1 and 8 and cisplatin 75 mg/m? on day 1 only. Radiotherapy (RT) was given as a phase treatment toa total dose of 70 Gyn 3 fractions. Concurrent cisplatin (75 mg/m) was administered tall patients ‘on days 1, 22 and 43. All patiente were evalated for tumor response and adverse effects after IC and 6 weeks after the completion of the treatment protocol Statistical analysic was performed using SPSS version 17 and Kaplan Meier estimates were applied to prajet survival. Median follow-up duration was 20 months. The -year ‘overall survival (OS), loco regional control (LLRC) and relapse free survival (RES) rates were 71%, 73% and _S0erespectively. Acute grade dtoxicity rdated to induction chemotherapy and concurrent chem-radiation was 4% and 2% respectively, with only 3 toxkcty-related hospital admissions. We conclude that induction gemcitabine ‘and cisplatin followed by chemo-radiation is a safe and effective regimen in management of nasopharyngeal ‘carcinoma, meriting further investigation in randomized clinical trials. Keywords: Nasopharyngeal cancer - concurteat chemo radiotherapy - induction chemotherapyFailure patterns and survival in patients with nasopharyngeal carcinoma treated with intensity modulated radiation in Northwest China: A pilot study Jianhua Wang", Mei Shi"t, Yuesheng Hsia, Shanquan Luo, Lina Zhao, Man Xu, Feng Xiao, Xuehai Fu, Jianping Li Bin Zhou and Yiaoli Long ‘Abstract Purpose: To evaluate the clinical outcomes and pattern of flue in patients with nasopharyngeal carcinoma (NPQ) treated with intensity modulated radiotherapy (MRT in Northwest China. ‘Methods and materials: From January 2006 to December 2008, 138 NPC patients were tected at Xing Hospital. OF them, 25 cases with stage Hl received IVRT only, 113 cases with stage IW received INIRT plus eccomplished platinum-based chemotherapy. The IMFT prescibed dese was PTV 68-74 Gy to gross disease in nasopharynx and 66-72 Gy to positive lymph nodes in 30-33 fractions, and high risk and low risk tegion PTV was 60-53 Gy and 504-5 Gy in 30-23 and 28 factions respectively. Plasma Epstoin Bar virus (EBY) DNA load was measured before tteatment The clinical toxicities, outcomes and patterns of faire were observed, Results: The mecian folow up time was 23 months (fange 2 to 53 months) EBV infection postive vies cnly 159% vera disease falure developed in 36 patients, 95% belonged to stage IIVIV disease. Amona these, there were 25 distant metastases 6 local recurrence, and 4 regional recurrence. The 3-year loca contialrate(LCR), distant metastassshee survival (MFS) dsease-ree survival (DFS) and the overall survival (05) was 93.9%, 795%, 70% and 23.195 respectively. Multvaiate analyces revealed that age and anemia pxe-radiatherapy were independent predictors for OS. ‘Conclusion: IMRT with o° without chemotherapy can improve the long term sunvval of NPC patients in Northwest China, Distant metastasis becomes the main cause of teatment failure. Age and anemia before raciatherapy were the main prognosis factors of NPC patients. Keywords: nasopharyngeal carcinoma, intensity modulated radiotherapy, chemotherapy, pattern af fale, survival Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinomas Herbert H. Loong, Brigette B.Y. Ma E4) Sing-Fai Leung, Frankie Mo, Edwin P. Hui, Michael K. Kam, Stephen LChan, Biian KH. Yu, Anthony TC ChanAbstract Full Text Images References Abstract Background and purpose ‘Concurrent chemoracictherapy (CRT) confers survival benefitover raciatherapy (RT) alone in the teaiment of ‘ocoregionally advanced nasopharyngeal carcinoma (NPC). This study expiored the prognoste significance of ‘he total dose of cisplatin delivered during CRT Materials and methods [Aretrospective analysis was performed in patients with stage Io IVE NPC |AJCC 6th edition) who participated |n3 prospective studies. Al patients received cisplatin ata fed dose of 40 mgim2week during a 6-T-neeks ‘course of CRT. Chi-square test was used in the univariate analysis. Relationship between prognosic factors, ‘he total dose of cisplatin administered and time-to-evantendpoints were analyzed with the Cox Hazards model, Results Two hundred and ‘orty-one patients were identfied wih tne folowing stage distrbuton: Stage II= 13.7%, I 45.2%, IV =41.1% The median total number of cycles of isplatn administerec ner natientwas 6 cycles (ange 1-8 cycles), Ata median follow-up of 56.5 months (range 42-200 2 months), 93 patients (38.6%) had relapsed ano 85 patients (35 2%) died. For all patents, ne fo'a| number of cycles of cisplatin delivered was signifcantly ‘associated wth survival in he univanate but not ine multivarate analysis. In @ sub-group analysis of 142 patients wth stage Il and III NPC, patents who received more than 5 cycles of cisplatin nao significant beter overall survwval than these who did nat (hazard rato 0.44: 95% confidence interval, 0.23~0.85:p = 0.02). Conclusion Number of cycles of cisplatin delivered is an independent prognostic factor in patents with siage Hil NPC. undergoing CRT with weekly cisplatin© Dose delivery analysis of weekly versus 3.weekly cisplatin concurrent with radiation therapy for locally advanced nasopharyngeal carcinoma (NPC). (ei0:23111356) ‘Abstract || Citations © Related Articles © | External Links @ Jagdis Las Hao D. HayL Wil Hoc Affiliations» Acnsrican Journal of Clinical Oncology [2014 37163 69) Type (DOK: 10:1097/C0C. 05013631 2500612 © Abstract OBJECTIVE: The purpose of this study was to analyze the dose delivery and toxicity of weekly ospiatin versus high-dose cisplatin gvan avery 3 weeks ina teriary oncology clinic. METHODS: From January 2600 ta July 2009, ppatiente with biopsy proven nazapharyngeal carcinema receiving concurrent cigplatin with curstive intent radiotion therepy (RT) were included, Before 2095, most patients received cisplatin (Q3) (100 mg/m Incravenously days 1, 22, and 43 of RT) and 3-dimensional conformal RT (0 Gy, 33 fractions). After 2005, most patients receved weekly cisplatin (1) (40 mg/m intravenously weekiy for 7 ws of RT) and intensity-modulated radiatherapy (70 Gy, 35 fractions), RESULTS: Seventy-three patients were analyzedt 45 for (1 and 28 for 03 (Cumulative daces 3200 mg/m were achiave in 89% cf Q1 ard 86H of Q2 patients, respectively, Doze reduction due to toxicity was requiredin 2/85 (4%) of QI potients compared with 11/23 (25%) oF Q3 patients (P-0.0093), Toxicities in Qf and Q3 patients included: hospitelization for acute zoxicity in 20% and 35.7%, mean weight loss 10.85% ard 8.75%; percutaneous endoscopic gastrostomy tube placement in 25.6% anc 29.6% and grade 3 ‘dehydration in 11.194 ano 17.9%, respectively. Mecian follow-up time was 3 years for Q1 anc 6 years for G3 patients. Median disease-free survival was 46 months for the Q1 group and 53 merchs for the Q3 group (P=0.667). Thare was re difference in everall survival between Qt and Q3. CONCLUSIONS: In this series, waakly 40 mg/m cisplatin end 3-veekly 100 mg/m cisplatin showed similar deliverability, toxicity profiles, and ‘outcomes. At cur center, weekly cisplatin is Standard af care for pacients with locally advanced nasopharyngeal ‘carcinoma undergoing chemoradiotherapy.Original Article Progress Report of a Randomized Trial Comparing Long-Term Survival and Late Toxicity of Concurrent Chemoradiotherapy With Adjuvant Chemotherapy Versus Radiotherapy Alone in Patients With Stage Ill to IVB Nasopharyngeal Carcinoma From Endemic Regions of China ‘Yong Chon, MD’: Ving Sun, MD, PRD": Shac-2a Liang, MD*:ing-Feng Zong, MD": Want Li, MDE Mo Chen, MD': Lei Chan, MD Van-Ping Mao, MD’: Ling-Long Tang, MD Ving Guo, PAD“: ArHua Lin, MO, PAD‘; Merg-Zhong Lis MO: end Jun Ma, MD [BACKGROUNO: The objective ofthis study was 1o evaluate the longterm sunival and late toes of concumertachwant chemo- ‘therapy patents wth Stage I rroeah IVS rasconaryngea carcinoma (NPC) Rom encemlefelers ©” Cana. METHODS: Pacers wi stage It to V8 NPC were assiIgnec random fo reawveracotnerapy (RT) alone (ie RT oFOUD) O RT US Concurrent sjWaNt ‘Chemotherapy (the CRT group). CRT patients receives concurrent cpatin (40 maf) weekly during RT fellowes! by ebplatin (60 ‘mafr®) and Rurouract (808 mo/mt daly for © days) every 4 wecks tor 3 eyes The primary endpoint was over srvva [RESULTE In tal, IG patients underwent racemization, with 3 to each group. Ato mdian follow-up of 70 monte he Seat ‘vera curva ata se TI forthe CRT group and 624 forthe RT grup (Razer rio, OG OSH confcence vera, 048-39) B= a2) Fahuredree sural wae sontcanty Noner the CaY graun (2m 020) Most late toecties were amiar ESS ve 26%: ‘P= 088). except fr cranial neuropathy (2=.042).peroheta neuropathy (P= O40. an ear damage (P= O48) wien were signe ‘any nefeased io the CRT group, CONCLUSIONS: The soston of Concent acjuantchemorTerap/ to RT provices sural Bane ‘ist patents with stage I through VB NPC in erceric regions of China pdt coms ot inrause most late totes apa Fam ceri! neuropthy, ercheal newrepatt, ard ear damage Cancer 201511922508, © 2015 American Carea Socey. EYWORDS: clei: cries iat concurant.acuvantchamatheroy:Fusreuracl natopharyngeal finer.