Current and emerging treatment options for nasopharyngeal carcinoma

Figures & data

Table 1 Trial design of randomized Phase II trials comparing concurrent chemo-RT to RT alone

Study (authors or trial)	N	Stage (AJCC)	RT (Gy)	Concurrent chemotherapy	Adjuvant chemotherapy	Ref
Al-Sarraf et al (USA)	147	III–IV (1992)	70	CDDP 100 mg/m^2 3 cycles	CDDP 80 mg/m^2 + 5-FU 1000 mg/m^2 3 cycles	^Citation1
Chan et al (Hong Kong)	350	Ho’s N2/3 or node ≥ 4 cm	66 ± 10–20 Gy boost	CDDP 40 mg/m^2 weekly	NA	^Citation11
Lin et al (Taiwan)	284	III–IV (1992)	70–74	CDDP 20 mg/m^2/d × 4d +5-FU 400 mg/m^2/d × 4d 2 cycles	NA	^Citation5
Kwong et al (Hong Kong)	219	Ho’s T3 or N2/3 or node ≥ 4 cm	66–68 ± 10 Gy boost	UFT 600 mg daily	CDDP/5FU + VBM 3 cycles	^Citation4
Zhang et al (Guangzhou)	115	III–IV (1997)	70–74	OXAL 70 mg/m^2/wk	NA	^Citation70
Wee et al (Singapore)	221	III–IV (1997)	70	CDDP 25 mg/m^2/d × 4d 3 cycles	CDDP 20 mg/m^2/d × 4d + 5FU 1000 mg/m^2/d × 4d	^Citation3
Lee et al (Hong Kong)	348	III–IV (1997) Any T, N2-3	66 ± 10 Gy boost	CDDP 100 mg/m^2 3 cycles	CDDP 80 mg/m^2 + 5-FU 1000 mg/m^2 3 cycles	^Citation2
Lee et al (Hong Kong)	189	III–IV (1997) T3-4, N0-1	≥66 Gy in 5 or 6 fractions/week	CDDP 100 mg/m^2 3 cycles	CDDP 80 mg/m^2 + 5-FU 1000 mg/m^2 3 cycles	^Citation13
Chen et al (Guangzhou)	316	III–IV (1997)	70	CDDP 40 mg/m^2 weekly	CDDP 80 mg/m^2 + 5-FU 800 mg/m^2 3 cycles	^Citation14

Abbreviations: AJCC, American Joint Committee on Cancer; d, days; wk, weeks; 5-FU, fluorouracil; CDDP, cisplatin; OXAL, oxaliplatin; UFT, uracil and tegafur; VBM, vincristine, bleomycin, methotrexate; RT, radiotherapy.

Table 2 Outcomes of randomized Phase II trials comparing concurrent chemo-RT to RT alone

Study (authors or trial)	Median follow-up (months)	Time point (years)	Treatment arm	OS (%)	PFS (%)	DMFS (%)	Ref
Al-Sarraf et al (USA)	60	5	RT	37	29	1
			Chemo-RT	67	58
				P = 0.001	P < 0.001
Chan et al (Hong Kong)	66	5	RT	80	52	11
			Chemo-RT	90	60
				P = 0.049	P = 0.16
Lin et al (Taiwan)	65	5	RT	54	53	70	^Citation5
			Chemo-RT	72	72	79
				P = 0.002	P = 0.001	P = 0.058
Kwong et al (Hong Kong)	37	3	RT	77	58	71	^Citation4
			Chemo-RT	87	69	85
				P = 0.06	P = 0.14	P = 0.026
Zhang et al (Guangzhou)	24	2	RT	77	83	80
			Chemo-RT	100	96	92	^Citation70
				P = 0.01	P = 0.02	P = 0.02
Wee et al (Singapore)	38	2	RT	49	46	3
			Chemo-RT	67	59
				P = 0.008	P = 0.032
Lee et al (Hong Kong)	25	3	RT	78	62	73
			Chemo-RT	78	72	76	^Citation2
				P = 0.97	P = 0.027	P = 0.47
Lee et al (Hong Kong)	35	3	RT	83	68	81
			Chemo-RT	87	73	89
			A-RT	73	63	77
			Chemo-A-RT	88	88	97	^Citation13
				P = 0.65	P = 0.061	P = 0.029
Chen et al (Guangzhou)	29	2	RT	80	73	79
			Chemo-RT	90	85	87	^Citation14
				P = 0.003	P = 0.001	P = 0.024

Abbreviations: A-RT, accelerated radiotherapy; DMFS, distant metastases-free survival; OS, overall survival; PFS, progression-free survival; RT, radiotherapy.

Table 3 Randomized Phase II trials of induction chemotherapy and RT compared to RT alone

Study (authors or trial)	Median follow-up (months)	Time point (years)	Treatment arm	N	Regimen	OS (%)	PFS (%)	DMFS (%)	Ref
Chan et al (Hong Kong)	28.5	2	RT	40	66 Gy ± 7.5 Gy boost	80	72	76	^Citation15
			Induction-RTadjuvant chemo	37	CDDP 100 mg/m^2 + 5-FU 1000 mg/m^2	80	68	78
					2 cycles induction
					4 cycles adjuvant
						NS	NS	NS
International Nasopharynx	49	5	RT	168	70 Gy	46	30		^Citation16
Cancer Study Group			Induction-RT	171	BEC	40	40
VUMCA I					3 cycles
						NS	P < 0.01	SS
Chua et al (AOCOA)	30	3	RT	152	66–74 Gy	71	42		^Citation18
			Induction-RT	134	CDDP 60 mg/m^2 + Epi 110 mg/m^2	78	48
					2–3 cycles
						NS	NS	NS
Ma et al (Guangzhou)	62	5	RT	225	68–72 Gy ± 10–14 Gy boost w/EBRT or 20–24 Gy boost w/HDR	56	49	75	^Citation17
			Induction-RT	224	CDDP, 5-FU, Bleo	63	59	79
					2–3 cycles
						NS	P = 0.05	NS
Hareyama et al (Japan)	49	5	RT	40	66–68 Gy	48	43	56	^Citation20
			Induction-RT	40	CDDP 80 mg/m^2 + 5-FU 800 mg/m^2	60	55	74
					2 cycles
						NS	NS	NS

Abbreviations: 5-FU, 5-fluorouracil; AOCOA, Asian-Oceanian Clinical Oncology Association; BEC, bleomycin, epirubicin, and cisplatin; Bleo, bleomycin; CDDP, cisplatin; EBRT, External Beam Radiotherapy; Epi, epirubicin; Gy, Gray; HDR, high dose rate; OS, overall survival; PFS, progression-free survival; PWH, Prince of Wales Hospital; RT, ratiotheraphy; NS, not significant; DMFS; distant metastases-free survival.

Table 4 Outcomes on IMRT for NPC

Study (authors or trial)	N	Stage III/IV (%) (AJCC)	Time point (years)	OS (%)	LC (%)	RC (%)	DMFS (%)	Ref
Lee et al (UCSF)	67	70	4	88	97	98	66	^Citation36
Kam et al (Hong Kong)	63	57	3	90	92	98	79	^Citation71
Kwong et al (Hong Kong)	33	3	3	100	100	92	100	^Citation38
Wolden et al (MSKCC)	74	77	3	83	91	93	78	^Citation35
Lee et al (RTOG 02-25)	68	59	2	80	93	91	85	^Citation39
Tham et al (Singapore)	195	63	3	94	90		89	^Citation72
Lin et al (Fujian)	323	80	3	90	95	98	90	^Citation73
Wong et al (Hong Kong)	175	35	3	87	94	93	87	^Citation74
Ng et al (Hong Kong)	193	61	2	92	95	96	90	^Citation75
Xiao et al (Guangzhou)	81	100	5	75	95	76
Lai et al (Guangzhou)	512	52	5		93	97	84	^Citation77

Abbreviations: AJCC, American Joint Committee on Cancer; DMFS, distant metastasis-free survival. LC, local control; MSKCC, Memorial Sloan-Kettering Cancer Center; OS, overall survival; RC, regional control; RTOG, Radiation Therapy Oncology Group; UCSF, University of California San Francisco; IMRT, intensity-modulated radiation therapy; NPC, nasopharyndeal carcinoma.

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