Multidisciplinary treatment for advanced nasopharyngeal carcinoma

Of 30 nasopharyngeal carcinoma (NPC) cases seen from Jan. 1976 through Mar. 1984 at Tokyo Metropolitan Komagome Hospital, 19 previously untreated patients with more than 1-year follow-up were retrospectively investigated to confirm the effective treatment modality. The average age was 51 years; the ratio of male to female was 3.5:1. Fifteen were in stage IV, 3 in stage III, and 1 in stage II. These 19 patients were grouped into three treatment modalities: a) radiation +/- unplanned chemotherapy (RT +/- CM); b) radiation+unplanned cis-diamminedichloroplatinum (II)(CDDP)-based chemotherapy (RT + unplanned CDDP); and c) radiation + planned CDDP-based chemotherapy (RT + planned CDDP). Planned CDDP-based chemotherapy consisted of 20-50 mg/M2 CDDP, i.v. for 1 hr, 7.5-15 mg/body bleomycin (BLM), i.v. and/or 20-30 mg/body MTX, i.v. at weekly intervals with diuresis for at least 4 courses. Plasma platinum (Pt) concentration before and 1 hr after CDDP administration revealed a gradual increase due to accumulated protein-bound Pt, while free Pt remained transient. This regimen could be safely administered for at least 4 courses. The survival rate of RT + planned CDDP (n = 8) was 100% at maximum follow-up of 55 months, while RT +/- CM (n = 6) at maximum follow-up of 54 months and RT + unplanned CDDP (n = 5) at maximum follow-up of 38 months were 17 and 0%, respectively. Thus, we concluded that the most effective treatment modality for advanced NPC was RT+planned CDDP.