NEOADJUVANT CHEMOTHERAPY AND RADIOTHERAPY IN LOCALLY ADVANCED UNDIFFERENTIATED NASOPHARYNGEAL CARCINOMA

Twenty one patients with nonmetastatic locally advanced undifferentiated nasopharyngeal carcinoma were treated with chemotherapy and radiotherapy. According to TNM staging 8 patients had T4 and 16 patients (80%) had N2 or N3 disease.Two courses of Cisplatinum (P) and 5 Fluorouracil (F) chemotherapy were given before and also after radiation therapy. P was given 20 mg/m2, for 5 days as 30 minutes infusion and F was given 600 mg/m2, for 5 days as 24 hours continous infusion. Co-60 radiotherapy was given as 46 Gy to the primary lesions and upper cervical region, 50 Gy to the lower cervical region, 50 Gy to the lower cervical and bilateral supraclavicular regions. Boost therapy was given up to 66-70 Gy to the primary lesions with Co-60 and to the initial nodal lesions with electron. Induction chemotherapy response was evaluated in 16 patients for regional response and in 13 patients for primary local response. At regional disease objective response was achieved in 15 patients (93.7%) with 6 (37.5%) complete and 9 (56.2%) partial response. At primary local sites we achieved 9 (69.2%) partial responses. After completing radiation therapy the objective response was achieved in 18 (94.7%) patients with complete response in 17 (89.4%) patients and partial response in 1 (5.3%) patients. The treatments were well tolerated without any life threatening side effects.The median follow up period is 17 months and the first year progression free survival is 73 percent. In conclusion, induction chemotherapy and radiotherapy are very effective in locally advanced undifferentiated nasopharyngeal carcinoma.The effect of chemotherapy is mainly on regional disease and chemotherapy may increase the effect of sequential radiation therapy.