Abstract
The aim of this study was to evaluate the efficacy and the toxicity of paclitaxel and cisplatin in patients in concurrent radiotherapy for locally advanced nasopharyngeal carcinoma, and to see whether such a regime would be better tolerated than high dose cisplatin plus fluoracil in Chinese patients. Thirty-one patients with locally advanced nasopharyngeal carcinoma were enrolled. Patients were scheduled to receive two courses of concomitant chemotherapy, starting on day 1 and then day 28 during radiotherapy (70–76 Gy in 35–38 fractions in 7–7.5 weeks). Chemotherapy was given by intravenous infusion, paclitaxel 120 mg/m2 in 3 h, cisplatin 75 mg/m2 (25 mg/m2 days 1–3). Adjuvant therapy was paclitaxel 135 mg/m2 in 3 h, cisplatin 75 mg/m2 (25 mg/m2 days 1–3) on weeks 3, 6, 9 after radiotherapy. All patients completed radiotherapy, but for concomitant chemoradiotherapy, 20 of the 31 patients completed the 2 cycles of chemotherapy, while the other 11 could only receive 1 cycle due to various reasons. The median follow-up was 40 months, 2 patients developed locoregional recurrences, one of whom in the cervical lymph nodes, the other in the nasopharynx. The 3-year overall survival rate was 83.9% and the distant metastasis rate at 3 years was 13.6%. Grade 3–4 toxicities were neutropenia 12.9%, anaemia 6.45%, thrombocytopenia 3.22%, severe arrhythmia 3.2%, and hypersensitivity reaction 3.2%. In conclusion, paclitaxel with cisplatin as concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma is feasible, safe, and might improve regional control and survival rates in Chinese patients.
Similar content being viewed by others
References
Yi JL, Gao L, Huang XD et al (2006) Nasopharyngeal carcinoma treated by radical radiotherapy alone: ten-year experience of a single institution. Int J Radiat Oncol Biol Phys 65:161–168
Gao JM, Zeng YX, Cui NJ et al (2005) Staging 915 cases of nasopharyngeal carcinoma after simple radical radiotherapy—checkout of Fuzhou staging system (1992). Ai Zheng 24:1165–1172
Lee AW, Sze WM, Au JS et al (2005) Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys 61:1107–1116
He XY, Liu TF, He SQ et al (2007) Late course accelerated hyperfractionated radiotherapy of nasopharyngeal carcinoma (LCAF). Radiother Oncol 85:29–35
Zhu XD, Wei JB, Qu S et al (2007) Comparison of remote results of conventional fractionation radiotherapy and late course accelerated hyperfractionation radiotherapy for nasopharyngeal carcinoma. Chin J Radiat Oncol 16:321–324
Kwong DL, Sham JS, Au GK et al (2004) Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J Clin Oncol 22:2643–2653
Chua DT, Sham JS, Au GK (2004) A concurrent chemoirradiation with cisplatin followed by adjuvant chemotherapy with ifosfamide, 5-fluorouracil, and leucovorin for stage IV nasopharyngeal carcinoma. Head Neck 26:118–126
Jiang Y, Wei YQ, Luo F et al (2005) Gemcitabine and cisplatin in advanced nasopharyngeal carcinoma: a pilot study. Cancer Invest 23:123–128
Al-Sarraf M, LeBlanc M, Giri PG et al (1998) Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 16:1310–1317
Lee AW, Lau WH, Tung SY et al (2005) 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. J Clin Oncol 23:6966–6975
Mostafa E, Nasar MN, Rabie NA et al (2006) Induction chemotherapy with paclitaxel and cisplatin, followed by concomitant cisplatin and radiotherapy for the treatment of locally advanced nasopharyngeal carcinoma. J Egypt Natl Canc Inst 18:348–356
Citrin D, Mansueti J, Likhacheva A et al (2009) Long-term outcomes and toxicity of concurrent paclitaxel and radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 74:1040–1046
Agarwala SS, Cano E, Heron DE et al (2007) Long-term outcomes with concurrent carboplatin, paclitaxel and radiation therapy for locally advanced, inoperable head and neck cancer. Ann Oncol 18:1224–1229
Pignon JP, le Maitre A, Bourhis J (2007) Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): an update. Int J Radiat Oncol Biol Phys 69:S112–S114
Disilvestro PA, Walker JL, Morrison A et al (2006) Radiation therapy with concomitant paclitaxel and cisplatin chemotherapy in cervical carcinoma limited to the pelvis: a phase I/II study of the Gynecologic Oncology Group. Gynecol Oncol 103:1038–1042
Kao J, Conzen SD, jaskowiak NT et al (2005) Concomitant radiation therapy and paclitaxel for unresectable locally advanced breast cancer: results from two consecutive phase I/II trials. Int J Radiat Oncol Biol Phys 61:1045–1053
Hsu FM, Lin CC, Lee JM et al (2008) Improved local control by surgery and paclitaxel-based chemoradiation for esophageal squamous cell carcinoma: results of a retrospective non-randomized study. J Surg Oncol 98:34–41
Yap SP, Lim WT, Foo KF et al (2008) Induction concurrent chemoradiotherapy using Paclitaxel and Carboplatin combination followed by surgery in locoregionally advanced non-small cell lung cancer—Asian experience. Ann Acad Med Singapore 37:377–382
Langer CJ, Harris J, Horwitz EM et al (2007) Phase II study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation in recurrent squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Protocol 9911. J Clin Oncol 25:4800–4805
Fountzilas G, Tolis C, Kalogera-Fountzila A et al (2005) Paclitaxel, cisplatin, leucovorin, and continuous infusion fluorouracil followed by concomitant chemoradiotherapy for locally advanced squamous cell carcinoma of the head and neck: a Hellenic Cooperative Oncology Group Phase II Study. Med Oncol 22:269–279
Barone C, Grillo R, Dongiovanni D et al (2008) Induction chemotherapy followed by concurrent chemoradiotherapy in advanced head and neck squamous cell carcinoma. Anticancer Res 28:1285–1291
Hancock SB, Krempl GA, Canfield V et al (2008) Treatment of base of tongue cancer with paclitaxel, ifosfamide, and cisplatinum induction chemotherapy followed by chemoradiotherapy. Laryngoscope 118:1357–1361
Hu QY, Liu P, Wang L et al (2007) Concurrent chemoradiotherapy followed by adjuvant chemotherapy for stage III, IV a nasopharyngeal carcinoma. Ai zhen 26:394–397
Machtay M, Moughan J, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26:3582–3589
Rades D, Fehlauer F, Sheikh-Sarraf M et al (2008) Toxicity of two cisplatin-based radiochemotherapy regimens for the treatment of patients with stage III/IV head and neck cancer. Head Neck 30:235–241
Chan AT, Teo PML, Ngan RK et al (2002) Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III radiomized trial. J Clin Oncol 20:2038–2044
Demizu Y, Sasaki R, Soejima T et al (2006) Efficacy and feasibility of cisplatin-based concurrent chemoradiotherapy for nasopharyngeal carcinoma. Jpn J Clin Oncol 36:620–625
Vaupel P, Mayer A, Hockel M (2006) Impact Of hemoglobin levels on tumor oxygenation: the higher, the better? Strahlenther Onkol 182:63–71
Chau RM, Teo PM, Kam MK et al (2007) Dosimetric comparison between 2-dimensional radiation therapy and intensity modulated radiation therapy in treatment of advanced T-stage nasopharyngeal carcinoma: to treat less or more in the planning organ-at-risk volume of the brainstem and spinal cord. Med Dosim 32:263–270
Yeh SA, Tang Y, Lui CC et al (2005) Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 62:672–679
Kong L, Zhang YW, Wu YR et al (2006) Late side reactions of longterm survivors after radiotherapy for nasopharyngeal carcinoma. Chin J Radiat Oncol 15:151–156
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
He, XY., Hu, CS., Ying, HM. et al. Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 267, 773–778 (2010). https://doi.org/10.1007/s00405-009-1112-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-009-1112-7