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Annals of Oncology Advance Access published online on May 9, 2006
Annals of Oncology, doi:10.1093/annonc/mdl090
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© 2006 European Society for Medical Oncology
Received January 12, 2006
Revised March 23, 2006
Accepted March 24, 2006

original article

Paclitaxel, 5-fluorouracil and hydroxyurea concurrent with radiation in locally advanced nasopharyngeal carcinoma

A. S. C. Wong 1 *, R. A. Soo 1, J. J. Lu 2, K. S. Loh 3, K. S. Tan 3, W. S. Hsieh 4, T. P. Shakespeare 2, E. T. Chua 5, H. L. Lim 1, and B. C. Goh 1

1 Department of Hematology-Oncology, National University Hospital, Singapore
2 Department of Radiation Oncology, National University Hospital, Singapore
3 Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
4 Division of Biomedical Sciences, Johns Hopkins in Singapore, Singapore
5 Department of Therapeutic Radiology, National Cancer Centre, Singapore

* To whom correspondence should be addressed.
A. S. C. Wong, E-mail: Alvin_SC_WONG{at}nuh.com.sg


  Abstract

Background: Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced nasopharyngeal carcinoma (NPC). We conducted a phase II trial using paclitaxel, 5-fluorouracil and hydroxyurea concurrent with radiation (TFHX).

Patients and methods: Fifty-nine patients with locally advanced NPC were treated with CRT consisting of 4-day continuous infusions of paclitaxel (20 mg/m2/d) and 5-fluorouracil (600 mg/m2/d), and oral hydroxyurea 500 mg bid for nine doses, every 3 weeks concurrent with radiotherapy (RT). RT consisted of once daily 200cGy fractions 5 times per week to a total of 7000cGy.

Results: Complete response was seen in 86% and 71% of patients at 4 and 12 months after CRT. The median follow-up was 34 months. Twenty-three patients experienced relapse. Sixteen deaths occurred: 13 from progressive disease. Three-year overall survival and progression-free survival were 72% and 54% respectively, with locoregional and distant control rates of 83% and 64% at 3 years respectively. Grade 3 to 4 acute toxicities included oropharyngeal mucositis in 81% of patients treated, dermatitis in 63%, weight loss in 32%, and neutropenia in 22%. Neutropenic fever was seen in 14%. There were no treatment-related deaths from acute toxicity.

Conclusions: TFHX is shown to be feasible in NPC. Non-cross resistant induction chemotherapy should be further studied with this regimen.

Keywords: 5-fluorouracil; hydroxyurea; nasopharyngeal carcinoma; paclitaxel; radiotherapy.
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