Intergroup 0099: chemoradiotherapy versus radiotherapy in advanced nasopharyngeal cancer
Adding cisplatin during radiotherapy and chemotherapy afterwards more than doubled the chance of being alive without disease three years later compared with radiotherapy alone, making chemoradiotherapy the standard for advanced nasopharyngeal cancer.
Overview
US Intergroup randomised phase 3 trial of patients with stage III to IV nasopharyngeal carcinoma comparing radiotherapy alone with radiotherapy plus concurrent cisplatin followed by three cycles of adjuvant cisplatin and fluorouracil; 147 patients were analysed after early closure for efficacy.
Three-year progression-free survival was 69 percent with chemoradiotherapy against 24 percent with radiotherapy, and overall survival 76 percent against 46 percent. The result established concurrent cisplatin with radiotherapy as the backbone of treatment worldwide.
- Three-year progression-free survival 69 percent with chemoradiotherapy versus 24 percent with radiotherapy alone.
- Three-year overall survival 76 percent versus 46 percent.
Concurrent cisplatin with radiotherapy is the foundation of treatment for locoregionally advanced nasopharyngeal carcinoma; later trials in endemic regions refined the role of induction and adjuvant chemotherapy.
- Conducted in a non-endemic population with a high proportion of keratinising tumours and an unusually poor radiotherapy-alone arm.
- Two-dimensional radiotherapy; the contribution of the adjuvant chemotherapy component has been questioned.
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