Abstract
Background
To study the impact of adding induction chemotherapy to radiotherapy on the long‐term control of regional metastasis and survival in patients with nasopharyngeal carcinoma (NPC).
Methods
Between February 1988 and August 1993, 240 NPC patients with Ho's T3 stage, N2–3 stage, or nodal size ≥3 cm were recruited onto two randomized trials comparing induction chemotherapy followed by radiotherapy (CT + RT) and radiotherapy alone (RT) using a similar treatment protocol. Of these, 210 patients (105 in each treatment arm) had cervical nodal metastasis and were included in the analysis. Patients in the CT + RT arm received two to three cycles of cisplatin, 60 mg/m^2^ day 1, + epirubicin, 110 mg/m^2^ day 1, followed by radiotherapy. Radiotherapy technique and dose were similar in both arms. The median follow‐up time was 71 months (range, 5–152 months).
Results
The overall response rate of nodal disease to chemotherapy was 86%, and the complete response (CR) rate was 44%. At the end of radiotherapy, 92% of patients in the CT + RT arm and 86% in the RT arm achieved CR in the neck (p = .12). The 5‐year nodal relapse‐free survival rates in the CT + RT and RT arm were 83% and 75%, respectively (p = .13). Most neck failures (81%) occurred during the first 36 months of follow‐up. Radical neck dissection successfully salvaged 41% of neck failures in the CT + RT arm and 46% in the RT arm. The 5‐year distant metastases‐free survival rates were 70% in the CT + RT arm and 68% in the RT arm (p = .56), and the corresponding 5‐year disease‐specific survival rates were 66% and 68%, respectively (p = .55). In subgroup analysis, no significant differences in regional control and survival could be found in patients with Ho's N2–3 stage, AJCC N2–3 stage, or nodal size >6 cm.
Conclusions
Induction chemotherapy does not seem to improve the regional control and survival in NPC patients with regional metastasis compared with radiotherapy alone and is not recommended as a routine treatment outside the context of a clinical trial. © 2002 Wiley Periodicals, Inc. Head Neck 24: 350–360, 2002; DOI 10.1002/hed.10056