Treatment Outcome of Cisplatin-based Concurrent Chemoradiotherapy in the Patients with Locally Advanced Nasopharyngeal Cancer
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Purpose: The standard treatment of locally advanced nasopharyngeal cancer is a concurrent chemoradiotherapy (CCRT), and cisplatin has been used as the most popular chemotherapeutic agent. But many different doses and schedules for cisplatin administration such as daily, weekly and 3 week cycles have been proposed. We compared and analyzed the tumor response, the overall survival, the toxicity and the chemotherapy dose intensity in the patients with locally advanced nasopharyngeal cancer who were treated with CCRT. Materials and Methods: We performed a retrospective study on 55 patients with locally advanced nasopharyngeal cancer, and they were treated with CCRT as a front-line treatment from Jan 1996 to Jun 2007 at Kangnam Saint Mary's Hospital. Results: The patients had a median age of 53 years (range: 19∼75 years). Of the total 55 patients, a 3-week cycle of 100mg cisplatin was administered in 31 patients and 30 mg weekly cisplatin was administered in 24 patients combined with radiotherapy. Twenty one patients had a complete response and four patients had a partial response for a response rate of 71.4% (95% CI: 59.5∼83.3) after CCRT and followed by adjuvant chemotherapy. The complete response rates for the 30 mg and 100 mg cisplatin groups were 72.7% (95% CI: 54.9∼ 90.5) and 54.2% (95% CI: 36.7∼71.7), respectively (p= 0.23). The duration of CCRT in the 100mg cisplatin group was significantly longer than that of the 30mg cisplatin group (11.1±2.9 weeks vs. 9.0±1.2 weeks, p= 0.003). The major deviation group, which was defined as prolongation of the radiotherapy duration for more than 2 weeks, had a significantly lower objective response rate than did the non-deviation group (56.3% vs 84.2%, respectively, p= 0.002). The major severe toxicities were leucopenia (49.1%), pharyngoesophagitis (49.1%), anorexia (43.6%), nausea (41.8%) and vomiting (40%). Conclusions: Weekly 30mg cisplatin-based CCRT is a practical, feasible cisplatin schedule for the patients with locally advanced nasopharyngeal cancer in regard to decreasing the interruption of radiation treatment and decreasing the treatment-related acute toxicities.
Abstract
Purpose: The standard treatment of locally advanced nasopharyngeal cancer is a concurrent chemoradiotherapy (CCRT), and cisplatin has been used as the most popular chemotherapeutic agent. But many different doses and schedules for cisplatin administration such as daily, weekly and 3 week cycles have been proposed. We compared and analyzed the tumor response, the overall survival, the toxicity and the chemotherapy dose intensity in the patients with locally advanced nasopharyngeal cancer who were treated with CCRT. Materials and Methods: We performed a retrospective study on 55 patients with locally advanced nasopharyngeal cancer, and they were treated with CCRT as a front-line treatment from Jan 1996 to Jun 2007 at Kangnam Saint Mary's Hospital. Results: The patients had a median age of 53 years (range: 19∼75 years). Of the total 55 patients, a 3-week cycle of 100mg cisplatin was administered in 31 patients and 30 mg weekly cisplatin was administered in 24 patients combined with radiotherapy. Twenty one patients had a complete response and four patients had a partial response for a response rate of 71.4% (95% CI: 59.5∼83.3) after CCRT and followed by adjuvant chemotherapy. The complete response rates for the 30 mg and 100 mg cisplatin groups were 72.7% (95% CI: 54.9∼ 90.5) and 54.2% (95% CI: 36.7∼71.7), respectively (p= 0.23). The duration of CCRT in the 100mg cisplatin group was significantly longer than that of the 30mg cisplatin group (11.1±2.9 weeks vs. 9.0±1.2 weeks, p= 0.003). The major deviation group, which was defined as prolongation of the radiotherapy duration for more than 2 weeks, had a significantly lower objective response rate than did the non-deviation group (56.3% vs 84.2%, respectively, p= 0.002). The major severe toxicities were leucopenia (49.1%), pharyngoesophagitis (49.1%), anorexia (43.6%), nausea (41.8%) and vomiting (40%). Conclusions: Weekly 30mg cisplatin-based CCRT is a practical, feasible cisplatin schedule for the patients with locally advanced nasopharyngeal cancer in regard to decreasing the interruption of radiation treatment and decreasing the treatment-related acute toxicities.
참고문헌 (24)
- Wei WI, "Nasopharyngeal carcinoma", Lancet, 365, pp.2041~54 (2005)
- Cho WC, "Nasopharyngeal carcinoma: molecular biomarker discovery and progress", Mol Cancer, 6, pp.1~ (2007)
- Chan AT, "Nasopharyngeal carcinoma", Ann Oncol, 13, pp.1007~15 (2002)
- Qin DX, "Analysis of 1,379 patients with nasopharyngeal carcinoma treated by radiation", Cancer, 61, pp.1117~24 (1988)
- Al-Sarraf M., "Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: Phase III randomized Intergroup study 0099", J Clin Oncol, 16, pp.1310~7 (1998)
- Vokes EE, "Concomitant chemoradiotherapy: Rationale and clinical experience in patients with solid tumors", J Clin Oncol, 8, pp.911~34 (1990)
- Al-Sarraf M., "Treatment of locally advanced head and neck cancer: Historical and critical review", Cancer control, 9, pp.387~99 (2002)
- Wee J., "Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer", International Union Against Cancer stage III and IV nasopharyngeal cancer of the endemic variety, 2005, pp.23, 6730~8
- Lin JC, "Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival", J Clin Oncol, 21, pp.631~7 (2003)
- Baujat B., "Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma", 2007 The Cochrane Collaboration
- Kwong DL, "The effect of interruptions and prolonged treatment time in radiotherapy for nasopharyngeal carcinoma", Int J Radiati Oncol Biol Phys, 39, pp.703~10 (1997)
- Isobe K., "Concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: is intergroup study 0099 feasible in Japanese patients", Jpn J Clin Oncol, 33, pp.497~500 (2003)
- Kwong DL, "Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: A factorial study", J Clin Oncol, 22, pp.2643~53 (2004)
- Chitapanarux I., "Chemoradiation comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: Randomized, non-inferiority, open trial", Eur J Cancer, 43, pp.1399~406 (2007)
- O'Meara WP, "Advances in nasopharyngeal carcinoma", Curr Opin Oncol, 17, pp.225~30 (2005)
- "RTOG acute radiation morbidity scoring criteria"[URL]
- Cheng SH, "Long-term survival of nasopharyngeal carcinoma following concomitant radiotherapy and chemotherapy", Int J Radiat Oncol Biol Phys, 48, pp.1323~30 (2000)
- Bahl M., "Tolerability of the Intergroup 0099 (INT 0099) regimen in locally advanced nasopharyngeal cancer with a focus on patients' nutritional status", Int J Radiat Oncol Biol Phys, 60, pp.1127~36 (2004)
- Chen YP, "Causes of interruption of radiotherapy in nasopharyngeal carcinoma patients in Taiwan", Jpn J Clin Oncol, 30, pp.230~4 (2000)
- Reddy SP, "Prognostic significance of keratinization in nasopharyngeal carcinoma", Am J Otolaryngol, 16, pp.103~8 (1995)
- Marks JE, "The national cancer data base report on the relationship of race and national origin to the histology of nasopharyngeal carcinoma", Cancer, 83, pp.582~8 (1998)
- Chua DT, "Prognostic value of epidermal growth factor receptor expression in patients with advanced stage nasopharyngeal carcinoma treated with induction chemotherapy and radiotherapy", Int J Radiat Oncol Biol Phys, 59, pp.11~20 (2004)
- Chan AT, "Multicenter, phase II study of cetuximab in combination with carboplatin in patient with recurrent or metastatic nasopharyngeal carcinoma", J Clin Oncol, 23, pp.3568~76 (2005)
- Hak Choy, "Chemoradiation in cancer therapy", pp.9~50 (2003), Humana Press