neo adjuvant chemotherapy followed by concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma
Purpose/Objective
Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy (NAC-CCRT) is an alternative strategy for decreasing tumor size and controlling micrometastases before main treatment. The aim of this study was to investigate
Material/Methods
This retrospective study included consecutive histologically confirmed Locally Advanced Nasopharyngeal cancer patient treated with NAC-CCRT at the Institute of Oncology RABAT Hospital during the January 2018 to December 2021.
CCRT protocols consisted of 3-week cycles of cisplatin 100 mg/m2 with concurrent radiotherapy. NAC consisted of 3-week cycles of cisplatin on day 1 and, 5 fluorouracil on days 1–4, or Doxorubicine on day 1 for a maximum three cycles.
Results
Of the 257 patients that received treatment during the study period,
86% patient received NAC-CCRT, and 14 % patient received CCRT (p < 0.001).
Median follow-up was 36 months. Significantly more patients with advanced clinical stage (stage IVA-IVB).
Toxicities were reported at 42% of the patients, with a higher incidence of neutropenia ,anemia, nausea and vomiting ,renal toxicity and radiomucositis Grade 3 and 4.
At a Median follow-up of 48 months, locoregional control was found in 75% of patients treated, with 11 % of recurrence and 4% metastatic progression. 6% of patients died of their cancer and 4% were lost to follow-up
Conclusion
In patients that received neo adjuvant chemotherapy, locoregional relapse should be of concern. High-risk distant metastasis patients (N3 stage) that could achieve survival advantage from NAC-CCRT is an interesting and important topic for further study.
