Chemoradiation Boosts Survival in Patients With Nasopharynx Cancer

ASCO--The preliminary results of an Intergroup study of patientswith locally advanced nasopharyngeal cancer show a highly significantimprovement in survival with the use of chemoradia-tion, comparedwith radiation alone, Muhyi Al-Sarraf, MD, said at the ASCO plenarysession.

Median progression-free survival is 13 months on the radiationalone arm and has not been reached in the combination arm, saidDr. Al-Sarraf, of the Providence Cancer Center, Southfield, Michigan.

Three-year progression-free survival is an estimated 65% for thecombination therapy arm vs 24% for the radiation only arm (P =.0001). Median survival is 2 years better in the combination arm(60 months vs 34 months), and estimated 3-year survival is 31%better (76% vs 45%, P = .0017.)

Nasopharyngeal carcinoma, although rare in the United States,is common across the world and is especially prevalent in southernChina, Southeast Asia, North Africa, the Middle East, and amongEskimos. The incidence in this country may be increasing due toimmigration from these areas. Migrants continue to have a higherincidence, even into the second and third generations, he said.

The experimental arm received the same radiation dose as the standardarm plus concurrent cisplatin (Platinol), 100 mg/m² givenon day 1 and every 3 weeks for 3 doses. At the end of chemoradiation,patients received an additional three courses of reduced-dosecisplatin and fluorouracil.

At present, 150 patients have been analyzed, the majority withT4 or T3 disease. An important point, Dr. Al-Sarraf said, is thatthere have been no toxicity-related deaths and no grade 5 toxicityin either arm.

Edward Vokes, MD, of the University of Chicago, said that concurrentcisplatin and radiation followed by adjuvant cis-platin/fluorouracilshould now be considered standard therapy for locoregion-allyadvanced nasopharyngeal cancer.

"Given the magnitude of the differences, both in time toprogression and survival, confirmatory trials in this diseaseare not necessary nor would they be practical," Dr. Vokessaid.