Preliminary results of a randomized study (NPC-9902 Trial) on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (China)
- Tuen Mun Hospital, Hong Kong (China)
- Prince of Wales Hospital, Hong Kong (China)
- Department of Biostatistics, University of Wisconsin Medical School, Madison, WI (United States)
- Queen Elizabeth Hospital, Hong Kong (China)
- Cancer Center, Sun Yat Sen University, Guangzhou (China)
- National Cancer Center, Singapore (Japan)
- Queen Mary Hospital, Hong Kong (China)
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario (Canada)
- Center for Clinical Trials, Chinese University of Hong Kong, Hong Kong (China)
- Center for Epidemiology and Biostatistics, Chinese University of Hong Kong, Hong Kong (China)
Purpose: To compare the benefit achieved by concurrent chemoradiotherapy (CRT) and/or accelerated fractionation (AF) vs. radiotherapy (RT) alone with conventional fractionation (CF) for patients with T3-4N0-1M0 nasopharyngeal carcinoma (NPC). Methods and Materials: All patients were irradiated with the same RT technique to {>=}66 Gy at 2 Gy per fraction, conventional five fractions/week in the CF and CF+C (chemotherapy) arms, and accelerated six fractions/week in the AF and AF+C arms. The CF+C and AF+C patients were given the Intergroup 0099 regimen (concurrent cisplatin plus adjuvant cisplatin and 5-fluorouracil). Results: Between 1999 and April 2004, 189 patients were randomly assigned; the trial was terminated early because of slow accrual. The median follow-up was 2.9 years. When compared with the CF arm, significant improvement in failure-free survival (FFS) was achieved by the AF+C arm (94% vs. 70% at 3 years, p = 0.008), but both the AF arm and the CF+C arm were insignificant (p {>=} 0.38). Multivariate analyses showed that CRT was a significant factor: hazard ratio (HR) = 0.52 (0.28-0.97), AF per se was insignificant: HR = 0.68 (0.37-1.25); the interaction of CRT by AF was strongly significant (p = 0.006). Both CRT arms had significant increase in acute toxicities (p < 0.005), and the AF+C arm also incurred borderline increase in late toxicities (34% vs. 14% at 3 years, p = 0.05). Conclusions: Preliminary results suggest that concurrent chemoradiotherapy with accelerated fractionation could significantly improve tumor control when compared with conventional RT alone; further confirmation of therapeutic ratio is warranted.
- OSTI ID:
- 20850063
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 66, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2006.03.054; PII: S0360-3016(06)00680-8; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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