The results of radiotherapy alone in patients with locally advanced nasopharyngeal carcinoma (NPC)
were disappointing. Cisplatin-based concomitant chemoradiotherapy (CCRT) has demonstrated higher rates of
local control and significantly reduced distant metastasis than radiotherapy (RT) alone in patients with locally
advanced NPC. In view of the high rate of severe mucosal and bone marrow toxicities reported with the high
doses of cisplatin and based on many studies that reported on the efficacy of weekly low dose cisplatin given
concomitantly with RT, it was a standard in our department to treat such patients with radiochemotherapy
utilizing low dose of weekly cisplatin. The aim of this retrospective study is to investigate the efficacy and
tolerability of low dose cisplatin CCRT in terms of overall survival (OS), disease free survival (DFS) , local
control rate (LCR) and, treatment related morbidities.
Methods: We revised the registered data in the fiies of patients with nasopharyngeal carcinoma treated in Sohag
Cancer Institute and the Department of Clinical Oncology in Sohag University Hospital between August 1999
and November 2012. Thirty two patients with locally advanced, non metastatic, nasopharyngeal carcinoma are
found in our research. Twenty five patients were treated with CCRT using low dose of weekly cisplatin were
compared with seven patients treated with RT alone.
Results: At the end of treatment, complete response (CR), partial response (PR) and, stable disease (SD)
were attained in 68%, 20% and, 8% with CCRT versus 57%, 28.5% and 14% with RT alone (P=0.11).
During follow up, although the rate of loco regional distant control (LRD) control in CCRT group was 41%
versus 50% for the RT group, such a finding was not statistically significant (P=0.74). The 5 year OS was
70% with CCRT versus 43% with RT alone (P=0.04) and 85 % in patients attained disease control versus
55% in those developed disease recurrence (P=0.01). The 5 year DFS was 46% versus 50% for CCRT versus
RT alone (P=0.27). Although more acute morbidities were observed in CCRT versus RT alone (92 vs 8%),
the difference was marginally significant (P=0.07). For chronic toxicities, more toxicities were associated
with radiotherapy dose at 70 Gy than with dose < 70 Gy but the difference also was marginally significant
(P=0.06)
Conclusion: In spite of the small number of patients in our study, our results are in agreement with many other
studies that support the concomitant approach in treating NPC. Weekly low dose cisplatin is easier to manage
than the three weekly cisplatin schedules with more tolerable toxicities. Further randomized studies comparing
both schedules are needed