Induction chemotherapy with paclitaxel and cisplatin, followed by concomitant cisplatin and radiotherapy for the treatment of locally advanced nasopharyngeal carcinoma.

Purpose: To evaluate the efficacy and outcome of neoadjuvant paclitaxel and cisplatin chemotherapy followed by concurrent cisplatin and irradiation in patients with locally advanced nasopharyngeal (NP) squamous cell carcinoma. Patients and Methods: The trial included 36 patients with locally advanced nasopharyngeal squamous carcinoma presented to Radiation Oncology and Otolaryngology departments - Ain Shams university hospitals, and Sohag Cancer Center between November 2002 and March 2006. Eligible patients were treated first with three cycles of induction chemotherapy (IC), paclitaxel (175mg/m2 on day 1) and cisplatin (80mg/m2 on day 1) followed by concomitant conventionally fractionated radiation (70Gy in 2Gy fractions) and cisplatin 20-mg/m2/day on days 15, 22-26 and 43-47 of the radiation therapy. Results: Twenty nine patients (80%) and 32 patients (89%) achieved objective response after IC and concomitant chemoradiation (CCRT) respectively. The actuarial 3 years survival was 68%, and the actuarial 3 year progression free survival (PFS) was 66%. Survival and PFS were significantly better for patients with smaller tumor volume (stage III), compared with patients with stage IV. Thirteen patients (36%) have elements of local and/or regional failure and 5 patients (14%) have an element of distant metastasis. Neutropenia (25%), mucositis (22%) and vomiting (20%) were the most severe toxicities recorded (grade 3 and 4) during IC while mucositis (36%), dermatitis (28%), anemia (14%) and vomiting (14%) were the most pronouncing toxicities (grade 3 and 4) during CCRT. Conclusions: IC followed by CCRT treatment program is feasible, tolerable and safe. This strategy improved