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Carcinoma de nasofaringe localmente avanzado: resultados finales del tratamiento de quimiorradioterapia seguido de quimioterapia complementaria

Locoregionally advanced nasopharyngeal carcinoma: final results of treatment with chemoradiotherapy followed by adjuvant chemotherapy

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Abstract

Resultados finales de tolerancia, control local y supervivencia de un estudio fase II con quimioterapia y radioterapia radical en el tratamiento del carcinoma nasofaríngeo localmente avanzado. Entre septiembre de 1986 y mayo de 1996 fueron tratados 45 pacientes. El tratamiento consistió en lomustina y ciclofosfamida simultánea con radioterapia sobre cavum y áreas ganglionares locorregionales (60-70 Gy) y posteriormente cada 4 semanas durante 1 año.

Cuarenta y tres pacientes (95%) finalizaron radioterapia. La mediana de ciclos por paciente fue 7. Se obtuvieron 29 respuestas completas (64%), 7 parciales (16%) y 4 progresiones (9%). Desarrollaron leucopenia grado III-IV 26 pacientes (57%) y xerostomía crónica 30 pacientes (67%). El fallo fue: locorregional, 12 pacientes (30%); mixto, 2 (5%), y a distancia, 7 (17%). Con una mediana de seguimiento de 102 meses, la supervivencia actuarial a 5 y 10 años fue del 39% y 23%, respectivamente, y la supervivencia actuarial libre de eventos a 5 y 10 años fue del 39% y 22%, respectivamente. Al cierre del estudio, 14 pacientes (31%) viven sin enfermedad.

Nuestros resultados reproducen los publicados en la literatura. La incidencia de recidivas locales y complicaciones tardías empleando técnicas convencionales es elevada. Se necesitan protocolos que disminuyan la morbilidad y mejoren la tasa de curación actual.

Abstract

The final results of tolerance, local control and survival from a phase II study in patients with locoregio nally advanced carcinoma who received concurrent chemo-radiotherapy followed by adjuvant chemotherapy are shown.

Between September 1986 and May 1996, 45 patients were enrolled in a trial of cyclophosphamide and lomustine concurrent with radiotherapy over the primary lesion and cervical-supraclavicular areas (60-70 Gy), followed by the same chemotherapy every four weeks during one year.

Forty three patients (95%) completed the radiotherapy. The median number of chemotherapy cycles was 7. There were 29 (64%) complete responses, 7 (16%) partial responses and 3 (9%) progressions. Twentysix (57%) patients had grade III-IV leucopenia and 30 patients (67%) developed permanent xerostomia. Patterns of first failure were as follows: locoregional in 12 patients (30%), distant relapse in 7 patients (17%) and both locoregional and distant failure in 2 patients (5%). The median of follow-up was 102 months. The survival at 5 and 10 year was 39% and 23% respectively and the event-free-survival at 5 and 10 year was 39% and 22% respectively. At the end of the study, 14 patients (31%) are alive.

Our results are acceptable, but the local relapses and the incidences of long-term complications using conventional techniques are important. Improved radiotherapeutic techniques coupled with effective systemic therapy should further improve the prognosis of patients with nasopharyngeal carcinoma and decrease the acute and long-term morbidity.

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Authors and Affiliations

  1. Médica. Departamento de Oncología, Clínica Universitaria. Universidad de Navarra, Spain

    Esteban Salgado & José María López-Picazo

  2. Servicio de Oncología Médica, Clínica San Miguel, Pamplona (Navarra)

    Joseba Rebollo

  3. Oncología Radioterápica. Departamento de Oncología, Clínica Universitaria. Universidad de Navarra, C./Pío XII, 36, 31008, Pamplona (Navarra)

    Marta Moreno, Ignacio Azinovic, Rosa María Cañón, César Beltrán, Rafael Martínez, Javier Aristu & Antonio Brugarolas

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Correspondence to Marta Moreno.

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Moreno, M., Salgado, E., Azinovic, I. et al. Carcinoma de nasofaringe localmente avanzado: resultados finales del tratamiento de quimiorradioterapia seguido de quimioterapia complementaria. Rev Oncología 2, 301–308 (2000). https://doi.org/10.1007/BF02979593

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