Preliminary Results of a Randomized Study on Therapeutic Gain by Concurrent Chemotherapy for Regionally-Advanced Nasopharyngeal Carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group

TLDR

The study compared concurrent chemoradiotherapy to radiotherapy alone in patients with advanced nodal nasopharyngeal carcinoma to evaluate therapeutic benefit and noted that longer follow‑up is needed. Patients were randomized to receive identical radiotherapy with or without cisplatin and fluorouracil chemotherapy (100 mg/m² cisplatin on days 1, 22, 43 and 80 mg/m² cisplatin plus 1,000 mg/m²/d fluorouracil for 96 h on days 71, 99, 127), with 348 participants and a median follow‑up of 2.3 years. Concurrent chemoradiotherapy produced a 10 percentage‑point higher 3‑year failure‑free survival (72 % vs 62 %) mainly through better locoregional control (92 % vs 82 %) but did not improve distant control or overall survival, and was associated with significantly higher acute (84 % vs 53 %) and late (28 % vs 13 %) toxicities.

Abstract

This randomized study compared the results achieved by concurrent chemoradiotherapy (CRT) versus radiotherapy (RT) alone for nasopharyngeal carcinoma (NPC) with advanced nodal disease.Patients with nonkeratinizing/undifferentiated NPC staged T1-4N2-3M0 were randomized to CRT or RT. Both arms were treated with the same RT technique and dose fractionation. The CRT patients were given cisplatin 100 mg/m2 on days 1, 22, and 43, followed by cisplatin 80 mg/m2 and fluorouracil 1,000 mg/m2/d for 96 hours starting on days 71, 99, and 127.From 1999 to January 2004, 348 eligible patients were randomly assigned; the median follow-up was 2.3 years. The two arms were well-balanced in all prognostic factors and RT parameters. The CRT arm achieved significantly higher failure-free survival (72% v 62% at 3-year, P = .027), mostly as a result of an improvement in locoregional control (92% v 82%, P = .005). However, distant control did not improve significantly (76% v 73%, P = .47), and the overall survival rates were almost identical (78% v 78%, P = .97). In addition, the CRT arm had significantly more acute toxicities (84% v 53%, P < .001) and late toxicities (28% v 13% at 3-year, P = .024).Preliminary results confirmed that CRT could significantly improve tumor control, particularly at locoregional sites. However, there was significant increase in the risk of toxicities and no early gain in overall survival. Longer follow-up is needed to confirm the ultimate therapeutic ratio.