Medical treatment of nasopharyngeal cancers

##plugins.themes.academic_pro.article.main##

Sameh Tebra
A Kallel
Hamouda Boussen
Noureddine Bouaouina

Abstract

Nasopharyngeal cancers are essentially epidermoids (NPC) and dominated by the undifferentiated type (UCNT) in endemic areas.
The standard treatment of NPC remain external beam radiotherapy but the results are poor in T3-4 lesions locally advanced (30-40% on event- free survival vs 80-90% in T1-T2) explained by a higher rate of relapse and metastases.
Improvement of therapeutic results occurs with addition of chemotherapy to radiotherapy, specially with the concomitant scheme (weekly cisplatin), with an increase of overall and diseasefree survivals for the advanced stages (Meta-analysis data). Despite these progresses, we have to evaluate the risk of long term sequelae of combined therapies in children and adolescents. We are observing however an epidemiologic transition with the increase of more localized cases in term of T and N disease.

Keywords:

Nasopharyngeal carcinoma, chemotherapy, radiotherapy, concomitant chemo-radiation, sequelae,

##plugins.themes.academic_pro.article.details##

References

  1. Boussen H, Bouaouina N. Cancer du nasopharynx (cavum). Encycl Méd Chir (Elsevier, Paris), Oto-rhinolaryngologie, 20-590-A-10, 1999,23p
  2. Boussen .H, Bouaouina .N, Mokni-Baizig .N, et al. Carcinomes du nasopharynx: données actuelles. Pathol Biol.2005; 53:45-51.
  3. Eschwège F, B. El Gueddari, Bourkhis. J. Carcinomes du nasopharynx, Aspects cliniques, indications et résultats de la radiothérapie transcutanée et de la curiethérapie. Etat de la question en 2001. Cancer Radiothérapie 2001; 5 (S1): 189-194.
  4. Tebra.Mrad.S, Makni.A , Bannour.N, et al. Le cancer du cavum : aspects épidémiologiques, cliniques et résultats thérapeutiques. Cancer Radiothérapie 2005 ; 9: 351-574
  5. Boussen .H; Gritli S; Touati et al. Ostéosarcome secondaire après traitement pour carcinome indifférencié du nasopharynx (UCNT).Bull Cancer 1997;84:1115-8.
  6. KongL, Lu JJ, Hu C et al .The risk of second primary tumors in patients with nasopharyngeal carcinoma after definitive radiotherapy. Cancer 2006; 107:1287-93.
  7. Wang CC. Accelerated hyperfractionation radiation therapy for carcinoma of the nasopharynx.Techniques and results. Cancer 1989;63: 2461-7.
  8. Lin JC, Cenky Y, Hou CY. Partially hyperfractionated accelerated radiotherapy and concurrent chemotherapy for advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1996;36:1127-36.
  9. Teo PML, Kwan WH, Leung SF, et al. Early tumor response and treatment toxicity after hyperfractionated radiotherapy in nasopharyngeal carcinoma. Br J Radiol 1996; 69: 241-8.
  10. Jen YM, Lin YS, Su WF, et al. Dose escalation using twice-daily radiotherapy for nasopharyngeal carcinoma: does heavier dosing result in a happier ending. Int J Radiation Oncol Biol Phys 2002 ; 54:14-22.
  11. Slevin .NJ, Wilkinson JM, Filby HM, Gupta NK. Intracavitary radiotherapy boosting for nasopharyngeal cancer. Br J Radiol 1997; 70: 412- 4.
  12. Teo PML, Leung S F, Lee WY, Zee B. Intracavitary brachytherapy significantly enchances local of early stage nasopharyngeal carcinoma: the existance of a dose- tumor -control relationship above conventional tumoricidal dose. Int J Radiat Oncol Biol Phys 2000: 46: 446-58
  13. Teo PML, Leung S F , Choi P, Lee WY, Johnson PJ. After loading radiotherapy for local persistance of nasopharyngeal carcinoma. Br J Radiol 1994; 67: 181- 5.
  14. J M Ardiet, R Coquard, D Peiffert, X Montbarbon, M Pernot, JP Gérard. Curiethérapie de rattrapage des cancers ORL. Bull Cancer /Radiother 1995; 82:199-202.
  15. Kondziolka D, Lunsford LD. Stereotactic radiosurgery for squamous cell carcinoma of the nasopharynx. Laryngoscope 1991; 101: 519- 22.
  16. Cmelak AJ, Cox RS, Adler JR, et al . Radiosurgery for skull base malignancies and nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1997; 37: 997 -1003.
  17. Tate DJ, Adler JR, Chang SD, et al. Stereotactic radio surgical boost following radiotherapy in primary nasopharyngeal carcinoma: impact on local control. Int J Radiat Oncol Biol Phys 1999; 45: 915 - 21.
  18. Kutcher GJ, Fuks Z, Brenner H, et al. Tree- dimensional photon treatment planning for carcinoma of the nasopharynx. Int J Radiat Oncol Biol Phys 1991; 21: 169 -82.
  19. Kam MK, Chau RM, Suen J, Choi PH, Teo PM. Intensitymodulated radiotherapy in nasopharyngeal carcinoma: dosimetric advantage over conventional plans and feasibility of dose escalation. Int J Radiat Oncol Biol Phys 2003; 56:145-57.
  20. Hunt MA, Zelefsky MJ, Wolden S, et al. Treatment planning and delivery of intensity modulated radiation therapy for primary nasopharynx cancer. Int J Radiat Oncol Biol Phys 2001; 49:623- 632.
  21. Sultanem K, Shu HK, Xia P et al. Three dimensional intensitymodulated radiotherapy in the treatment of nasopharyngeal carcinoma: The university of California-San Francisco experience. Int J. Radiat Oncol Biol Phys. 2000; 48: 711-722.
  22. Porceddu S, Hop G, Will J et al. Intensity-modulated radiotherapy: examples of its utility in head and neck Cancers. Australas Radiol. 2004; 48:51-7.
  23. Lee AW, Poon YF, Foo W, et al. Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976-1985: Overall survival and patterns of failure. Int J Radiat Oncol Biol Phys 1992; 23: 261- 70.
  24. International Nasopharynx Cancer Study Group VUMCA I trial.Preliminary results of a randomized trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage IV (V> or = N2, M0) undifferentiated nasopharyngeal carcinoma: a positive effect on progression-free survival. Int J Radiat Oncol Biol Phys 1996; 35: 463 -69.
  25. Ma J, Mai HQ, Hong MH, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with loco regionally advanced nasopharyngeal carcinoma. Cancer 2002; 94: 2217-23.
  26. Chua DT, Sham JST, Choy D, et al. Preliminary report of the Asian- Oceanian Clinical Oncology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Cancer 1998; 83: 2270- 83.
  27. Hareyama M, Sakata K, Shirato H, et al. Aprospective, randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in patients with advanced nasopharyngeal carcinoma. Cancer 2002; 94: 2217-23.
  28. Chua DT, Ma J, Sham JS et al. Improvement of survival after addition of induction chemotherapy to radiotherapy in patients with early-stage nasopharyngeal carcinoma: Subgroup analysis of two phase III trials. Int J Radiat Oncol Biol Phys 2006; AUG 1; 65: 1300-6.
  29. Rossi A, Molinari R, Boracchi P, et al. Adjuvant chemotherapy with vincristine, cyclophosphamide, and doxorubicin after radiotherapy in local-regional nasopharyngeal cancer: Results of a 4-year multicenter randomized study. J Clin Oncol 1988; 6: 1401-10.
  30. Chi KH, Chang YC, Guo WY, et al. A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients. Int J Radiat Oncol Biol Phys 2002; 52: 1238- 44.
  31. Al-Sarraf M, Leblanc M, Giri S, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup Study 0099. J Clin Oncol 1998; 16: 1310-17.
  32. Wee J, Tan EH, Tai BC, et al. Phase III randomized trial of radiotherapy versus concurrent chemo-radiotherapy followed by adjuvant chemotherapy in patients with AJCC/UICC (1997) stage 3 and 4 nasopharyngeal cancer of the endemic variety. Proc Am Soc Clin Oncol 2004 (abstract 5500): 487.
  33. Lee AWM, Lau WH, Tung SY, et al. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 2005; 23:6966-75.
  34. Oh JL, Vokes EE, Kies MS, et al. Induction chemotherapy followed by concomitant chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal cancer. Ann Oncol 2003; 14: 564 - 69.
  35. Chan AT, Leung SF, Ngan R, et al. Overall survival after concurrent cisplatin- radiotherapy versus radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Nat Cancer Inst.2005; 97:536-9.
  36. Lin JC, Jan JS, Hsu CY, et al. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol 2003; 21: 631- 37.
  37. Langendijk JA, Leemans R, Buter J, Soltman B. A Meta-analysis of the addition of chemotherapy in locally advanced nasopharyngeal carcinoma. J Clin Oncol 2004; 22:4604-12.
  38. Baujat B, Audry H, Bourhis J et al. Chemotherapy in locally advanced nasopharyngeal carcinoma: an in dividual patient data meta-analysis of eight randomised trials and 1753 patients. Int J Radiat Oncol Biol Phys. 2006; 65:958- 9.