Neo Adjuvant Chemotherapy plus Volumetric-Modulated Arc Therapy for the Treatment of Loco Regionally Advanced Nasopharyngeal Carcinoma: A Retrospective Study

Author(s):

Rolina Al-Wassia, Essam Senan, Ahmed Mohamed Ameen M Ahmed, Mohammed Sheikh Al-Amoodi, Zuhair Natto, Osama Yousof, Azhar Nawaz, Ahmed AHussein, Firas R Abisheffah, Zaheeda Mulla, Shadi Al-Khayyat and Reyad Dada

Background and Purpose: Nasopharyngeal carcinoma is attributed for 33 percent of head and neck malignancy in Saudi Arabia. In treatment of NPC, chemo radiotherapy is used as a modality of choice. The present study aims to determine the effect of Neo Adjuvant Chemotherapy NACT in Local Control LC and Overall Survival OS of NPC patients treated in King Faisal Hospital and Research Center KFSHRC, Jeddah, Saudi Arabia. Materials and Methods: Patients treated for NPC were retrospectively studied. Demographic characteristics and chemotherapy data were collected and analyzed. Kaplan-Meier product-survival estimates and multivariate analysis were conducted to describe and determine the effect of NACT plus CCT in LC and OS. Results: Seventyseven patients with loco regional advanced NPC were studied. Majority of the patients had Stage 3 NPC n=34, 44.2 percent and had undifferentiated non-keratinizing carcinoma type III n=70, 90.9 percent. Fifty-three of these patients received VMAT 68.8 percent as radiation treatment wherein 27, 50.9 percent had NACT plus CCT, while 22 41.5 percent received CCT only. Data revealed only sixty-nine NPC patients underwent chemotherapy in which thirty-three 42.9 percent received Concomitant Chemotherapy CCT and thirty-nine 46.8 percent received NACT plus CCT. Multivariate analysis showed most CCT patients n=32, 50.8 percent did not experience relapse and incidence was slightly lower compared to the NACT plus CCT group n=31, 49.2 percent. However, a significant difference was not observed between the two groups. Kaplan-Meier showed incidence of relapse mostly happened in the first three years of therapy while death was observed mostly between 1 years and 2.5 years after. Conclusion: Our study showed similar survival outcomes for CCT and NACT plus CCT. However, CCT reported a lower incidence of relapse than the group receiving NACT plus CCT.