Nasopharyngeal carcinoma is endemic in Southeast Asia and China with increased incidences in the Mediterranean countries. It is relatively rare in the United States and Continental Europe. It differs markedly from other head and neck cancers based on its distinct histology, its association with EBV, its marked responsiveness to chemotherapy, and its rapid growth with early dissemination. Presentation is commonly a locally advanced stage with nodal involvement or metastases.
A combined modality approach with chemotherapy and radiation has become standard treatment for nasopharyngeal carcinoma. The most notable prospective trial to date examined induction with 5-FU and cisplatin followed by radiation. Since the introduction of effective chemotherapy as part of the salvage treatment after relapse in these patients with nasopharyngeal cancer, the 5-year survival rate in patients with stage IV disease who received radiation therapy as their initial treatment has risen to the 40% range.
Capecitabine has been studies in a number of phase II studies, especially Chinese studies, yielding response rates of 20-30+%. One study claimed 48% response. Overall, the studies suggest that it is a moderately effective treatment and supported by several phase II trials. A phase I trial has been completed with radiation: Phase I Trial of Induction Paraplatin® and Xeloda® Followed by Concurrent Paraplatin and Xeloda With Intensity Modulated Radiotherapy for Locally Advanced Squamous Cell Carcinoma of the Head and Neck
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