Chemo for nasopharyngeal carcinoma – pro

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. The overall initial response rate was 93% and the 6 year survival was 67%.  Because of the poor results obtained with radiation therapy alone in patients with locally advanced disease, induction cisplatin-5FU before radiation therapy has been tested. The overall response rate to cisplatin-5FU is approximately 90%, and about 50% achieved CRs, with improved 5-year survival. Concurrent cisplatin/radiation therapy,which has been investigated by us and later by other investigators, produced higher CR rates and better 5-year survival rates. 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.

Although the stage is not clear form the submitted information, 5FU and cisplatin are standard therapy in most stage presentations of nasopharyngeal carcinoma.

Al-Sarraf M, Reddy MS. Nasopharyngeal carcinoma. Curr Treat Options Oncol. 2002;3:21-32.

Mould RF,Tai TH. Nasopharyngeal carcinoma: treatments and outcomes in the 20th century. Br J Radiol. 2002;75:307-339.

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