The final results of tolerance, local control and survival from a phase II study in patients with locoregio nally advanced carcinoma who received concurrent chemo-radiotherapy followed by adjuvant chemotherapy are shown.
Between September 1986 and May 1996, 45 patients were enrolled in a trial of cyclophosphamide and lomustine concurrent with radiotherapy over the primary lesion and cervical-supraclavicular areas (60-70 Gy), followed by the same chemotherapy every four weeks during one year.
Forty three patients (95%) completed the radiotherapy. The median number of chemotherapy cycles was 7. There were 29 (64%) complete responses, 7 (16%) partial responses and 3 (9%) progressions. Twentysix (57%) patients had grade III-IV leucopenia and 30 patients (67%) developed permanent xerostomia. Patterns of first failure were as follows: locoregional in 12 patients (30%), distant relapse in 7 patients (17%) and both locoregional and distant failure in 2 patients (5%). The median of follow-up was 102 months. The survival at 5 and 10 year was 39% and 23% respectively and the event-free-survival at 5 and 10 year was 39% and 22% respectively. At the end of the study, 14 patients (31%) are alive.
Our results are acceptable, but the local relapses and the incidences of long-term complications using conventional techniques are important. Improved radiotherapeutic techniques coupled with effective systemic therapy should further improve the prognosis of patients with nasopharyngeal carcinoma and decrease the acute and long-term morbidity.