Induction Chemotherapy Followed by Concurrent Chemo-conformal Radiation Therapy in Locally Advanced Nasopharyngeal Carcinoma

Background: Renewed interest in induction chemotherapy for treatment of locally advanced nasopharyngeal carcinoma has been made recently. Multiple phase III trials were going aiming to define the best candidate, and the best regimen for induction chemotherapy. We conducted this phase II study to evaluate the efficacy and safety of induction chemotherapeutic (TPF) regimen before CCRT with cisplatin weekly in locally advanced non metastatic NPC.

Methods: 36 patients diagnosed with stage III, IVA & IVB, poorly differentiated or undifferentiated carcinoma in the period between August 2014 and August 2016 were included in the study, all of them received induction chemotherapy with TPF regimen followed by cisplatin (40 mg/m²) weekly concurrent with RT. Radiotherapy was given by 3D conformal modality where, high-risk GTVP, GTVLN & CTV was given a dose of 60 Gray / 30 fractions followed by 10-14 gray/5-7 fractions to GTVP and 6-10 Gray /3-5 fractions to GTVLN.

Results: The objective response rate was 86% (CR 12%) in the primary tumor and, 100%                  (CR 62%) in the cervical LN after induction chemotherapy and the corresponding rate was 100% (CR 91%), 45-60 days after the completion of RT. No local recurrence or distant metastasis was seen during the follow-up period. The two-year DFS was 85% and the estimated two-year OS was 95%. The rate of grade 3 /4 neutropenic fever was encountered in 6% of cases during induction chemotherapy. Grade 3/4 mucositis was seen in 9 % of patients while no grade 3 or 4 skin desquamation or xerostomia were seen. There was no treatment-related death. Field in field technique gave the best coverage of the PTV without exceeding the tolerance dose of other OAR. Conclusion: The TPF regimen was well tolerated and had a manageable toxicity profile. 3DCRT can be tailored to reach the target of Intensity modulation modalities.