Gemcitabine And Cisplatin Followed by Chemo-Radiation for Advanced Nasopharyngeal Carcinoma

Concurrent chemo-radiation (CRT) has been established as the standard of care for non-metastatic locoregionallyadvanced nasopharyngeal carcinoma (NPC) but recently the addition of induction chemotherapy inthe already established regimen has presented an attractive multidisciplinary approach. This retrospective studywas carried out to evaluate the efficacy of induction chemotherapy (IC) followed by CRT for the management ofloco-regionally advanced NPC. Between July 2005 and September 2010, 99 patients were treated with cisplatinbased IC followed by CRT. Induction chemotherapy included a 2 drug combination; intravenous gemcitabine1000 mg/m2 on day 1 and 8 and cisplatin 75 mg/m2 on day 1 only. Radiotherapy (RT) was given as a phasetreatment to a total dose of 70 Gy in 35 fractions. Concurrent cisplatin (75 mg/m2) was administered to all patientson days 1, 22 and 43. All patients were evaluated for tumor response and adverse effects after IC and 6 weeksafter the completion of the treatment protocol. Statistical analysis was performed using SPSS version 17 andKaplan Meier estimates were applied to project survival. Median follow-up duration was 20 months. The 5-yearoverall survival (OS), loco regional control (LRC) and relapse free survival (RFS) rates were 71%, 73% and50%respectively. Acute grade 4 toxicity related to induction chemotherapy and concurrent chemo-radiation was4% and 2% respectively, with only 3 toxicity-related hospital admissions. We conclude that induction gemcitabineand cisplatin followed by chemo-radiation is a safe and effective regimen in management of nasopharyngealcarcinoma, meriting further investigation in randomized clinical trials.