Neoadjuvant Chemotherapy plus Plus Volumetricmodulated Arc Therapy for the Treatment of Loco Regionally Advanced Nasopharyngeal Carcinoma: A Retrospective Study

Author(s):

Rolina Al-Wassia*, 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 & Purpose: Nasopharyngeal carcinoma is attributed for 33% of head and neck malignancy in Saudi Arabia. In treatment of NPC, chemoradiotherapy is used as a modality of choice. The present study aims to determine the effect of Neoadjuvant 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 & Methods: Patients treated for NPC were retrospectively studied. Demographic characteristics and chemotherapy data were gathered 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%) and had undifferentiated non-keratinizing carcinoma (Type III) (n=70, 90.9%). Fifty-three of these patients received VMAT (68.8%) as radiation treatment wherein 27 (50.9%) had NACT plus CCT, while 22 (41.5%) received CCT only. Data revealed only sixty-nine NPC patients underwent chemotherapy in which thirty-three (42.9%) received Concomitant Chemotherapy (CCT) and thirty-nine (46.8%) received NACT plus CCT. Multivariate analysis showed most CCT patients (n=32, 50.8%) did not experience relapse and incidence was slightly lower compared to the NACT plus CCT group (n=31, 49.2%). However, a significant difference was not observed between the two groups. Kaplan-Meier analysis showed incidence of relapse mostly happened in the first three years of therapy while death was observed mostly between 1 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.