Nazofarenks Kanseri Tedavisinde Indüksiyon Tedavilerinin Retrospektif Değerlendirilmesi

Abstract

The standard treatment of local advanced nasopharyngeal cancer is chemoradiotherapy. Opinions regarding induction theraphy differ. In this study we retrospectively examined patients treated in our clinic and administered induction therapy. One hundred fifty-four patients were included, 76% (n= 117) male and 24% (n= 37) female. Mean age at diagnosis was 47 (20-73). Examination of patients? histopathologies revealed WHO grade I tumor in 1.3%, WHO grade II tumor in 48.1% and WHO grade III tumor in 34.3%. At time of diagnosis, 11.9% (n= 18) of patients were stage II, 36.4% (n=55) stage III and 51.7% (n= 78) stage IV. In terms of induction therapy, cisplatin-fluorouracil (CF) was administered to 24.7% (n= 38) of patients, docetaxel-cisplatin (DC) to 35.1% (n= 54) and docetaxel-fluorouracil (DCF) to 40.3% (n= 62). The predominant pathology in the CF group was undifferentiated carcinoma (44.7%), and nonkeratinizing carcinoma in the DC and DCF groups (57.4% - 45.2%) (p=0.004). There was no statistically significant difference between the treatment groups in terms of initial stage (p=0.24). Response levels to induction therapy in the CF group were 5.7% (n= 2) complete response, 82.9% (n= 29) partial response and 11.4 (n= 4) stable disease. In the DC group they were 11.4% (n= 5) complete response, 59.1% (n= 26) partial response and 25% (n= 11) stable disease, and 10.6% (n= 5) complete response, 74.5% (n= 35) partial response and 14.9% (n= 7) stable disease in the DCF group. Progression was only recorded in 4.5% (n=2) of patients in the DC group. No statistically significant difference was determined between the groups (p=0.20). Following induction, treatment was administered in the form of chemoradiotherapy (CRT) to 84.9% (n=129) of patients and radiotherapy (RT) to 15.1% (n=23). Repeat staging and response assessment were performed. Response assessment after CRT and RT revealed 69.4% (n= 25) complete response in the CF group, 74.5% (n= 38) complete response in the DC group and %71.4 (n= 40) complete response in the DCF group. Median length of follow-up was 50 months (2-201 months). Distant organ metastasis developed in 17.5% (n= 27) of patients during this time, and local recurrence in 13.6% (n= 21). In terms of induction therapy, distant organ metastasis was observed in 23.7% (n= 9) of patients receiving CF, 16.7% (n= 9) of those receiving DC and 14.5% of those receiving DCF (n=9) (P=0.49). Local recurrence was seen in 18.4% (n=7) of the CF group, 13% (n=7) of the DC group and 11.3% (n= 7) of the DCF group (p=0.59). Examination of progression-free survival (PFS) levels in nasopharyngeal cancer cases receiving induction therapy revealed 3-year PFS of 79.3% and 5-year PFS of 72.4%. There was no significant difference between the induction therapy groups (p=0.30). Patients? local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) times were compared on the basis of induction therapies received, but no significant difference was observed (p= 0.083- p= 0.068) Patients? 3-year general survival (GS) levels were 87.4% and 5-year GS levels 76%. In terms of induction therapies received, 3-year GS was 96.5% in the DCF group, 86.6% in the DC group and 76.3% in the CF group (p= 0.036). Our study results show that DCF therapy as an induction regimen in cases of nasopharyngeal cancer exhibited no advantage in disease-free survival but a significant advantage in survival. However, since our study was retrospective, our patient group was heterogeneous and detailed toxicity data were unavailable, the findings need to be interpreted with care.