The comparison of efficacy between concurrent DFP and PFB chemotherapy in combination with radiotherapy for 80 patients with nasopharyngeal carcinoma of stage III or IV

Objective: To compare the rales of local control, survival and toxicity of concurrent DFP (DOC, DDP plus 5-FU) versus PFB (DDP, 5-FU plus BLM) chemotherapy in combination with radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Methods: A total of 80 patients with stage-III or stage-IV nasopharyngeal carcinoma diagnosed pathologically, without distance metastasis, were randomly divided into two groups. The DFP chemotherapy regiment was administered as follows: docetaxel 60mg /m 2/d, i.v. infusion on day 1 (or day 1, days 8), cisplatin 25 mg/m 2/d, on day 2 to 5, 5-Fu 500 mg/m 2/d, on day 2 to 5. The PFB chemotherapy regiment was as follows: cisplatin 25 mg /m 2/d, on day 2 to 5, 5-Fu 500 mg/m 2/d, on day 2 to 5, pinyangmycin 16 mg, i.m, on day 1, 3 and 5. Each chemotherapy regiment was administered for 2 cycles, with 21 days each cycle. Radiotherapy was used by cobalt-60, with simultaneous chemotherapy. The patients were treated by conventional fraction. The accumulated radiation dose was 65 to 70Gy/6.5 to 7.5 weeks for primary tumor, 55 to 66Gy/6 to 7 weeks for the involved area of the neck was and 50Gy/5 weeks for the uninvolved area. Results: The overall response rate (complete response and part response) was 95.0% and 85.0% in DPF group and PFB group, respectively. The 1-year free from local regional failure survival rate (FLF) was 85.0% and 80.0% and the 1-year free-distant metastasis survival rate (FDM) was 90.0% and 70.0%. The difference of overall response rate and the 1-year FLF between the two groups were not statistically significant. The difference of 1-year FDM was statistically significant (P<0.05). The adverse effects were nause and vomiting. The main toxicity were acute inflammation of oral mucosa and leucopenia (grade III or IV was 50.0% or 40.0%) in the DPF group. The difference between the two groups was statistically significant. But these can be tolerable by using G-CSF. Conclusion: The short efficacy and the 1-year FLF between the DFP and the BFP group are clear. The 1-year FDM in the DFP group is better than the BFP group but the grade III or IV toxicity is higher, too. The measures should be taken to reduce the toxicity.