Chemotherapy Plus Radiation Improves Prognosis of Nasopharyngeal Carcinoma

Combining two widely known anticancer drugs with radiation therapycan dramatically improve the survival of patients with nasopharyngealcarcinoma, a new clinical trial has shown. In most cases, physiciansnow recommend only radiation therapy for such patients.

The new combined-modality treatment, which involved the use ofradiation plus cisplatin (Platinol) and fluorouracil, resultedin a 3-year survival rate of 76%. This compared to a 3-year survivalrate of 45% for patients receiving radiation therapy alone.

"This is the first prospective, randomized clinical trialfor head and neck cancer in many years to demonstrate improvedsurvival through the use of a combined treatment regimen,"said David E. Schuller, MD, director of Ohio State's ComprehensiveCancer Center-Arthur G. James Cancer Hospital and Research Institute.

Study Stopped Early

The results of combining the two modalities were so strongly positivethat the study stopped adding new patients in December and alltrial participants were given the combination treatment. To ensurethe accuracy of the results, there was an additional 6-month follow-upperiod during which the pronounced survival benefits were confirmedthrough additional analysis.

The results of the study were announced at the 32nd Annual Meetingof the American Society of Clinical Oncology in Philadelphia.

The study has greatest significance for Asia, North Africa, andthe Inuit population of the Canadian Yukon and Northwest Territories,where rates of nasopharyngeal carcinoma are higher than in theUnited States. Nasopharyngeal carcinoma is rare in the UnitedStates, with an incidence of 1 per 100,000 in the general populationand 10 per 100,000 in the Chinese-American population. The highestrates recorded by the International Agency for Cancer Researchare among the Chinese populations of Hong Kong and Singapore,with 28.5 cases per 100,000 and 18 cases per 100,000, respectively.

The trial, which was coordinated by the Southwest Oncology Group(SWOG), involved 150 patients with stage III or IV nasopharyngealcarcinoma, 81 of whom received chemotherapy plus radiation and69, radiation alone.

Nasopharyngeal carcinoma has an overall 5-year survival rate ofabout 40%, a 10-year survival rate of 28%, and a 20-year survivalrate of about 12%. Treatment of patients with stage I and stageII disease achieves management or cure in more than 75% of patients;treatment of advanced disease by the traditional means of radiotherapyalone has a success rate of only 20% to 50%.

Schuller, who also directs Ohio State's Head and Neck OncologyProgram, helped coordinate the study and chaired the Head andNeck Intergroup committee that made the study a nationwide trialin 1989. This committee included leaders in head and neck cancerfrom all the major national cancer cooperative groups. Anotherinvestigator at The James Cancer Center involved in the studywas Reinhard Gahbauer, MD, director of the Department of MedicalOncology. The James was one of the accruing institutions for thetrial.

The study's principal investigator was Muhyi Al-Sarraf, MD, directorof Providence Cancer Center, Detroit, Michigan. The intergrouptrial also involved the Radiation Therapy Oncology Group (RTOG)and the Eastern Cooperative Oncology Group (ECOG).