Tumor Biology

, Volume 34, Issue 3, pp 1729–1736 | Cite as

Concurrent chemoradiotherapy with or without adjuvant chemotherapy in intermediate and locoregionally advanced nasopharyngeal carcinoma

  • Wendong Zhang
  • Huiqin Dou
  • Chileong Lam
  • Jixi Liu
  • Jianfeng Zhou
  • Yunsheng Liu
  • Xiuwen WangEmail author
Research Article


Concurrent chemoradiotherapy (CCRT) showed a significant improvement in disease control and clinical outcome in patients with intermediate and locoregionally advanced nasopharyngeal carcinoma (NPC) (stage II, III and IVA+B). However, there has been debate about the contribution and application of additional adjuvant chemotherapy (AC) to a CCRT regime. This study aims to evaluate the additional value of AC in the treatment of intermediate and locally advanced NPC with regard to toxicity and clinical outcomes. A total of 189 patients with American Joint Committee on Cancer (AJCC) stage II to stage IVB NPC were retrospectively identified. Patient characteristics, toxicity, compliance with treatment and clinical outcomes, including response to treatment, overall survival (OS), progression-free survival (PFS), relapse-free survival (RFS), freedom from local recurrence (FLR) and freedom from distant metastasis (FDM), were analyzed. The overall response rate of CCRT and CCRT/AC groups was 97.92 % and 97.83 %, respectively (P = 0.643). The 5-year OS rate was 68.2 % in the CCRT group and 75.9 % in the CCRT/AC group (P = 0.53). The 5-year PFS rate was 66.7 % and 71.4 % in CCRT and CCRT/AC groups, respectively (P = 0.96). This study showed no evidence of an additional value of AC in CCRT treatment in disease control and clinical outcomes in patients with locally advanced NPC in endemic regions. Moreover, three additional cycles of AC after CCRT appeared to be poorly tolerated in patients. Therefore, AC should not be routinely used for treatment, although clinical trials may be justified.


Nasopharyngeal carcinoma Concurrent chemoradiotherapy Adjuvant chemotherapy 



We thank Dr. David Lopes, from the Department of Haemato-oncology, Conde S. Januario General Hospital, Macao SAR, and Dr. Weihua Wang from the Radiotherapy Center, Kiangwu Hospital, Macao SAR, for assistance in data collection.

Conflicts of interest

The authors have no potential conflicts of interest to be disclosed.


  1. 1.
    Chen WQ, Zheng RS, Zhang SW, et al. Report of incidence and mortality in china cancer registries, 2008. Chin J Cancer Res. 2012;24(3):171–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Kutcher GJ, Fuks Z, Brenner H, et al. Three-dimensional photon treatment planning for carcinoma of the nasopharynx. Int J Radiat Oncol Biol Phys. 1991;21:169–82.PubMedCrossRefGoogle Scholar
  3. 3.
    Al-Saraf M, LeBlanc M, Giri PG, et al. Chemotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup Study 0099. J Clin Oncol. 1998;16:1310–7.Google Scholar
  4. 4.
    Sanguineti G, Geara FB, Garden AS, et al. Carcinoma of the nasopharynx treated by radiotherapy alone: determinants of local and regional control. Int J Radiat Oncol Biol Phys. 1997;37:985–96.PubMedCrossRefGoogle Scholar
  5. 5.
    Chan AT, Leung SF, Ngan RK, et al. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005;97:536–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Lin JC, Jan JS, Hsu CY, et al. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003;21:631–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Zhang L, Zhao C, Peng PJ, et al. Phase III study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma: preliminary results. J Clin Oncol. 2005;23:8461–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Baujat B, Audry H, Bourhis J, et al. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys. 2006;64:47–56.PubMedCrossRefGoogle Scholar
  9. 9.
    Langendijk JA, Leemans CR, Buter J, et al. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol. 2004;22:4604–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Liu A, Swisher-McClure S, Millar LB, et al. Proton therapy for head and neck cancer: current applications and future directions. Transl Cancer Res. 2012;1:255–63.Google Scholar
  11. 11.
    Giap H, Giap B. Historical perspective and evolution of charged particle beam therapy. Transl Cancer Res. 2012;1(3):127–36.Google Scholar
  12. 12.
    Kyong Hwa P, Jeong Sun K, Yong P, et al. Concurrent chemoradiation followed by adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma in Korea. Cancer Chemother Pharmacol. 2010;66:643–51.CrossRefGoogle Scholar
  13. 13.
    Chen L, Hu CS, Chen XZ, et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012;13(2):163–71. Epub 2011 Dec 7.PubMedCrossRefGoogle Scholar
  14. 14.
    Edge SB, Byrd DR, Compton CC, et al. AJCC (American Joint Committee on Cancer) cancer staging manual. 7th ed. New York: Springer; 2010. p. 41–56.Google Scholar
  15. 15.
    Barnes L, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours. Pathology and genetics of head and neck tumors. Lyon: IARC Press; 2005.Google Scholar
  16. 16.
    Ma J, Mai HQ, Hong MH, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol. 2001;19(5):1350–7.PubMedGoogle Scholar
  17. 17.
    Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment. Cancer. 1981;47:207–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRefGoogle Scholar
  19. 19.
    Al-Kourainy K, Crissman J, Ensley J, et al. Excellent response to cis-platinum based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma. Am J Clin Oncol. 1988;11:553–7.CrossRefGoogle Scholar
  20. 20.
    Bachouchi M, Cvitkovic E, Azli N, et al. High complete response in advanced nasopharyngeal carcinoma with bleomycin, epirubicin, and cisplatin before radiotherapy. J Natl Cancer Inst. 1990;82:616–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Nakagawa K, Tsurutani J. Perspectives in drug development for cancer therapy in Asia. Chin Clin Oncol. 2012;1:17.Google Scholar
  22. 22.
    Dimery IW, Peters UI, Goepfert H, et al. Effectiveness of combined induction chemotherapy and radiotherapy in advanced nasopharyngeal carcinoma. J Clin Oncol. 1993;11:1919–28.PubMedGoogle Scholar
  23. 23.
    Ai P, Tu L, Sun L, et al. Multiple annular lung metastases from a nasopharyngeal carcinoma. Quant Imaging Med Surg. 2012;2:291.PubMedGoogle Scholar
  24. 24.
    Kwong DL, Sham JS, Au GK, et al. Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J Clin Oncol. 2004;22:2643–53.PubMedCrossRefGoogle Scholar
  25. 25.
    Chen Y, Liu MZ, Liang SB, et al. Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of China. Int J Radiat Oncol Biol Phys. 2008;71:1356–66.PubMedCrossRefGoogle Scholar
  26. 26.
    Zhang L, Zhao C, Ghimire Y, et al. The role of concurrent chemoradiation in the treatment of locally advanced nasopharyngeal carcinoma among endemic area: a meta-analysis of the phase III randomized trials. J Clin Oncol. 2008; 26:6032. (Available online at =34253, accessed June 3, 2009).Google Scholar
  27. 27.
    David GP, Kei-Kian A, David MB, et al. NCCN clinical practice guidelines in oncology——Head and Neck Cancers, Version I, 2012, pp 30–32.Google Scholar
  28. 28.
    Wee J. Eng Huat Tan, Bee Choo Tai, et al. 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. J Clin Oncol. 2005;23:6730–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Chua DT, Sham JS, Kwong DL, et al. Treatment outcome after radiotherapy alone for patients with Stage I–II nasopharyngeal carcinoma[J]. Cancer. 2003;98(1):74–80.PubMedCrossRefGoogle Scholar
  30. 30.
    Rassi A, Molinari R, Boracchi P, et al. Adjuvant chemotherapy with vincritine, cyclophosphamide, and doxorubicin after radiotherapy in local–regional nasopharyngeal cancer: results of a 4-year multicenter randomized study. J Clin Oncol. 1988;16:1401–10.Google Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2013

Authors and Affiliations

  • Wendong Zhang
    • 1
  • Huiqin Dou
    • 2
  • Chileong Lam
    • 3
  • Jixi Liu
    • 4
  • Jianfeng Zhou
    • 5
  • Yunsheng Liu
    • 2
  • Xiuwen Wang
    • 1
    Email author
  1. 1.Department of Clinical OncologyQilu Hospital of Shandong UniversityJinanChina
  2. 2.Department of StomatologyQilu Hospital of Shandong UniversityJinanChina
  3. 3.Department of Clinical OncologyConde S. Januario General HospitalMacauChina
  4. 4.Department of GastroenterologyChina Japan Friendship HospitalBeijingChina
  5. 5.Department of Medical Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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