演題抄録

International Symposium

開催概要
開催回
第51回・2013年・京都
 

Alternating chemoradiotherapy and EB virus in nasopharyngeal carcinoma

演題番号 : IS3-1

[筆頭演者]
Tomokazu Yoshizaki:1 
[共同演者]
Naohiro Wakisaka:1、shigeyuki Murono:1、Satoru Kondo:1、Kazuhira Endo:1、Akira Tsuji:1、Nobukazu Fuwa:2

1:Otolaryngology-Head and Neck Surgery, Kanazawa University, Japan、2:Hyogo Ion Beam Medical Center, Japan

 

Nasopharyngeal carcinoma (NPC) is chemoradiosensitive and highly metastatic cancer, which is contributed by Epstein-Barr virus (EBV). We have reported that EBV-encoded LMP1 promote metastasis by inducing MMP-1, MMP-9, c-Met, IL-8, VEGF etc. Thus, in addition to improve irradiation technique for controlling local disease, intensive chemotherapy is mandatory for controlling metastatic disease. The concurrent chemoradiotherapy with 3-course of cisplatin and adjuvant chemotherapy with 3-course of cisplatin + 5FU has been a prevalent regimen for advanced NPC since ISG 0099. However, only 55% could accomplish the protocol treatment. Alternating chemoradiotherapy has been adapted since 1990 and shown better outcome of this treatment. in Aichi Cancer Institute. From December 2003 to March 2006, 90 patients with Stage IIb or more advanced NPC were enrolled in prospective multicenter phase II study. The patients were treated with 3 course of 5-FU (800mg/m2 x 5days) plus cisplatin (50mg/m2 x 2days) and 2 course of irradiation (36 Gy between 1st and 2nd chemotherapy, 34Gy between 2nd and 3rd chemotherapy). Three patients were not eligible for the protocol treatment and 87 patients were enrolled for the efficacy analysis. Seventy-four patients (85.1%) completed this therapy. The 5-year overall and progression free survival rate were 78.0% and 68.4%, respectively. Commonly observed acute toxicities of Grade 3 or more were loss of appetite (47.7%), neutropenia (45.5%), and mucositis (31.8%).This alternating chemoradiotherapy protocol is more effective, less toxic than IGS-0099 protocol, and thus, promising treatment for advanced, and especially, EBV-associated NPC.

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