A concurrent chemoirradiation with cisplatin followed by adjuvant chemotherapy with ifosfamide, 5-fluorouracil, and leucovorin for stage IV nasopharyngeal carcinoma

Abstract

Background. To evaluate the toxicity and efficacy of concurrent chemoirradiation with cisplatin followed by adjuvant ifosfamide, 5‐fluorouracil and leucovorin in patients with stage IVb nasopharyngeal carcinoma (NPC) Patients and Methods. Between October 1998 and August 2001, 35 Chinese patients with stage IVb NPC (N3a:12, N3b:23) were treated with by concurrent chemoirradiation using cisplatin 100 mg/m² on days 1, 22, and 43 of radiotherapy, followed by adjuvant chemotherapy with 1.4 g/m², ifosfamide, 450 mg/m² 5‐fluorouracil, and 20 mg/m² leucovorin daily for 5 days and repeated every 3 weeks for three cycles. Radiotherapy was given using standard fractionation at 2 Gy/day to a total of 68 Gy to the nasopharynx and 66 Gy to the neck. Results. All patients completed the prescribed radiotherapy. Twenty‐three patients (66%) completed all scheduled cycles of chemotherapy. The compliance rate for concurrent and adjuvant chemotherapy was 71% and 80%, respectively. Grade 3 mucositis occurred in 37%, and grade 3 dermatitis occurred in 11.5% during radiotherapy. Grade 3 neutropenia occurred in 17% during concurrent chemotherapy, and grade 3–4 neutropenia occurred in 48.5% during adjuvant chemotherapy. There were no treatment‐related deaths. With a median follow‐up of 31 months, the 3‐year relapse‐free rate was 60%, and the 3‐year overall survival rate was 74%. Locoregional control was excellent, with a 3‐year local and nodal relapse‐free rate of 91% and 83%, respectively. Eleven patients (31%) had developed distant metastases, and the 3‐year distant metastasis‐free rate was 66%. Conclusions. The chemotherapy regimen tested is practical with an acceptable compliance rate. Despite having a more advanced stage disease, the observed outcome of our patients seems to be comparable with other series using platinum‐based adjuvant chemotherapy. Further investigation to confirm the benefit of using the study regimen in advanced stage NPC is warranted. © 2004 Wiley Periodicals, Inc. Head Neck26: 118–126, 2004