Familial Nasopharyngeal Carcinoma 6

Neoadjuvant Chemotherapy: Trials 14and ConclusionsAnne W. M. LeeCONTENTS14.1 Introduction 18314.2 Nonrandomized Studies on SequentialInduction Chemotherapy 18414.3 Randomized Trials on SequentialInduction Chemotherapy 18414.4 Phase II Clinical Studieson Induction–ConcurrentChemotherapy 18614.5 Ongoing Clinical Trials 19014.6 Summary 190References 190Anne W. M. Lee, MDDepartment of Clinical Oncology, Pamela Youde NethersoleEastern Hospital,3 Lok Man Road, Chai Wan, Hong Kong, SAR,P.R. China14.1IntroductionMegavoltage radiation therapy (RT) has been theprimary treatment modality for nasopharyngealcarcinoma (NPC). With improving technology andoptimization of dose fractionation, the treatmentoutcome has been steadily improving. However,while excellent control can be achieved for patientswith early disease, further improvements of resultsfor the majority of patients presenting with advancedlocoregional diseases are still needed.Retrospective analyses of 2,070 patients treated byRT alone (90% using 2D technique) from 1996 to 2000in Hong Kong showed that the 5-year overall survival(OS) was 85% for stages I–II and 66% for stages III–IVB NPC (Lee et al. 2005b). In particular, the 5-yeardistant failure-free rate (D-FFR) ranged from 93% forstage I to 67% for stage IV. Achievement of locoregionalcontrol was associated with improved distant control(D-FFR being 82 vs. 71%; p < 0.001). However, even forpatients who achieved locoregional control, the metastaticrate remained high (25% at 5-year) for patientspresenting with stages III–IV disease. Incorporation ofeffective systemic treatment is clearly needed.Clinical observation that NPC is highly responsiveto systemic chemotherapy was first reported in themid-1970s. Of 6 patients with NPC included as partof a trial on head and neck cancers, 3 completeresponses (CR) and 2 partial responses (PR) wereachieved using bleomycin (BLEO)-containing regimen(Richman et al. 1976). The first study specific forNPC by Decker et al. (1983) showed regression in53% (9/14) patients; the most effective chemotherapyregimens contained cisplatin (Cisplatin). These datakindled the interests in integrating chemotherapyinto a combined modality approach.