ASCO--The preliminary results of an Intergroup study of patients
with locally advanced nasopharyngeal cancer show a highly significant
improvement in survival with the use of chemoradia-tion, compared
with radiation alone, Muhyi Al-Sarraf, MD, said at the ASCO plenary
Median progression-free survival is 13 months on the radiation
alone arm and has not been reached in the combination arm, said
Dr. Al-Sarraf, of the Providence Cancer Center, Southfield, Michigan.
Three-year progression-free survival is an estimated 65% for the
combination 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 southern
China, Southeast Asia, North Africa, the Middle East, and among
Eskimos. The incidence in this country may be increasing due to
immigration from these areas. Migrants continue to have a higher
incidence, even into the second and third generations, he said.
The experimental arm received the same radiation dose as the standard
arm plus concurrent cisplatin (Platinol), 100 mg/m² given
on day 1 and every 3 weeks for 3 doses. At the end of chemoradiation,
patients received an additional three courses of reduced-dose
cisplatin and fluorouracil.
At present, 150 patients have been analyzed, the majority with
T4 or T3 disease. An important point, Dr. Al-Sarraf said, is that
there have been no toxicity-related deaths and no grade 5 toxicity
in either arm.
Edward Vokes, MD, of the University of Chicago, said that concurrent
cisplatin and radiation followed by adjuvant cis-platin/fluorouracil
should now be considered standard therapy for locoregion-ally
advanced nasopharyngeal cancer.