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. 2023 May-Jun;89(3):440-446.
doi: 10.1016/j.bjorl.2022.12.004. Epub 2022 Dec 28.

Treatment outcomes of alternating chemoradiotherapy for nasopharyngeal carcinoma: a single-center safety and efficacy study

Kenzo Ohara  1 , Miki Takahara  2 , Takumi Kumai  3 , Masaaki Yamashina  4 , Kan Kishibe  2 , Akihiro Katada  2 , Tatsuya Hayashi  2
Affiliations

Treatment outcomes of alternating chemoradiotherapy for nasopharyngeal carcinoma: a single-center safety and efficacy study

Kenzo Ohara et al. Braz J Otorhinolaryngol. 2023 May-Jun.

Abstract

Objective: To evaluate the efficacy and safety of Alternating Chemoradiotherapy (ACRT) using cisplatin and 5-Fluorouracil (5-FU) in patients with nasopharyngeal carcinoma.

Methods: This was a retrospective study in which patients' clinical records were reviewed to identify patients with a new diagnosis of nasopharyngeal carcinoma at our institution between January 2005 and January 2019. Thirty-seven eligible patients were identified; of these, the clinical details of 27 patients treated with ACRT were evaluated. Patient outcomes, including overall survival and progression-free survival, and adverse events were assessed.

Results: Of these initial 37 patients, 1, 10, 13, 10, and 3 were staged as I, II, III, IVA, and IVB, respectively, as defined by the 8th edition of the TNM classification system. Twenty-seven patients received ACRT comprising sequential administration of chemotherapy, radiotherapy (wide field), chemotherapy, radiotherapy (shrinking field), and chemotherapy. The 5-year overall survival and progression-free survival rates were 83.7% and 88.9%, respectively. Treatment compliance was 93%, which is comparable to that of previous reports.

Conclusion: ACRT using cisplating and 5-fluorouracil was well tolerated with acceptable efficacy.

Level of evidence: IVa.

Keywords: 5-fluorouracil; Alternating chemoradiotherapy; Cisplatin; Nasopharyngeal carcinoma.

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Figures

Figure 1
Figure 1
Study design of alternating chemoradiotherapy. During the course of chemotherapy (one-week period; three cycles), patients were irradiated at 2- or 3-day intervals of chemotherapy. 5-fluorouracil (5-FU) (800 mg/m2/day) was intravenously administered continuously for 24 h from days 1 to 5. Cisplatin (50 mg/m2/day) was intravenously administered continuously for 24 h from days 6 to 7. The same chemotherapy regimen was used in all three cycles of chemotherapy. Radiotherapy was delivered to the nasopharynx and whole neck, at 1.8–2 Gy/fraction, 5 fractions/week, until a dose of 50 Gy. Subsequent radiotherapy was delivered to the primary region and the remaining lymph nodes. The total dose during the study period was 68.4–73.4 Gy in 35–40 fractions.
Figure 2
Figure 2
Plasma EBV-DNA level before and after ACRT. (a) Plasma EBV-DNA before ACRT, (b) Plasma EBV-DNA three months after ACRT. Measurable EBV-DNA were detected in 13 of 27 cases. All 13 cases showed a decrease in EBV-DNA three months after ACRT.
Figure 3
Figure 3
Kaplan Meier plot of overall survival and progression-free survival for patients in each stage. The 5-year OS (a) and PFS (b) of nasopharyngeal patients treated with ACRT are shown. The 5-year OS and PFS rates were 83.7% and 88.9%, respectively.
See this image and copyright information in PMC

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