[Nasopharyngeal carcinoma: only irradiation or simultaneous radiochemotherapy?]

Between 1979 and 1997, a total of 92 patients with primary nasopharyngeal carcinoma were treated at the Hospitals of the University of Erlangen. Until 1988, radiotherapy alone was the treatment of choice and simultaneous radiochemotherapy was consistently applied thereafter. This retrospective analysis was performed to evaluate the influence of concurrent radiochemotherapy on survival and to identify possible prognostic factors on cause-specific survival-, locoregional tumor control- and distant-metastases-free survival rates.

Fifty-three patients (58%) received treatment by radiotherapy alone and 39 (42%) underwent primary radiochemotherapy with 2 courses of 5-FU and cisplatin. Median total dose to the bilateral neck region was 60 Gy (range, 50 to 62 Gy), and 74 Gy (range, 56 to 88 Gy) to the primary tumor. Median follow-up of the surviving patients was 8 years.

Following radiochemotherapy and radiotherapy alone, the 5-year-survival rates were 67% and 48%, respectively (p = 0.06). Female patients had a survival advantage as compared to male patients (5-year-survival rate 77% vs 44%, p = 0.01). Patients with and without cranial nerve palsy at presentation had survival rates of 0% and 61%, respectively, at 5 years (p = 0.01). Distant-metastases-free survival was influenced by the following factors: lymph-node involvement (NO: 82% vs N1 to N3: 68%, p = 0.04), gender (female: 88% vs male: 64%, p = 0.01), type of treatment (radiochemotherapy: 86% vs radiotherapy: 63%, p = 0.02) and cranial nerve involvement (76% without and 42% with involvement, p = 0.04).

In primary nasopharyngeal carcinoma simultaneous radiochemotherapy can significantly reduce distant metastases and improve survival as compared to radiotherapy alone. Since late toxicity rates were similar in both treatment groups and the slightly increased acute side effects following radiochemotherapy were effectively compensated by standard supportive care, patients with advanced nasopharyngeal carcinoma may benefit from simultaneous radiochemotherapy.