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

Author(s): Rolina Al-Wassia1,2*, Essam Senan2, Ahmed Mohamed Ameen M Ahmed2,3, Mohammed Sheikh Al-Amoodi4, Zuhair Nato5, Osama Yousof6, Azhar Nawaz7, Ahmed AHussein2, Firas R Abisheffah8, Zaheeda Mulla2, Shadi Al-Khayyat9 and Reyad Dada10,11

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.

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