Nasopharyngeal Cancer & Chemotherapy

Chemotherapy is important in the treatment of nasopharyngeal cancer. It is now generally considered standard therapy for all but the few early-stage cases. The optimal timing and role of chemotherapy have yet to be determined. Metastatic, undifferentiated carcinoma, or lymphoepithelioma, of the nasopharynx is highly sensitive to chemotherapy. In four consecutive studies involving a total of 165 patients treated with cisplatin-containing regimens for metastatic lymphoepithelioma, 19% achieved a complete response, and 64% had at least a partial response. Of patients, 12% were free of disease 3 years after chemotherapy, and 14 of 165 were disease free after at least 82 months (47).
Chemotherapy also has a role in the management of squamous cell carcinoma and lymphoepithelioma when disease is local. The most compelling results are from an intergroup trial in the United States in which 147 patients were randomized to RT alone or RT with concomitant cisplatin and postradiation therapy with cisplatin and 5-FU. The study was stopped early when a significant difference in 2-year survival rate occurred in favor of the chemotherapy arm. The 3-year survival rate for the patients who had chemotherapy was 78%; the 3-year survival rate was 47% for patients who did not have chemotherapy (P = 0.005) (48). Several other studies have shown similar results with the use of concomitant chemotherapy (49).

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