Lobaplatin combined with docetaxel neoadjuvant chemotherapy followed by concurrent lobaplatin with intensity-modulated radiotherapy increases the survival of patients with high-risk lymph node positive nasopharyngeal carcinoma.

PURPOSE: To evaluate the efficacy and safety of lobaplatin combined with docetaxel as neoadjuvant chemotherapy followed by concurrent lobaplatin with intensity-modulated radiotherapy (IMRT) for high-risk positive lymph node (N+) nasopharyngeal carcinoma (NPC).

METHODS

This study enrolled 37 primary high-risk N+ NPC patients. The neoadjuvant chemotherapy program consisted of lobaplatin (30 mg/m(2), day 1) plus docetaxel (75 mg/m(2), day 1) for two cycles, 3 weeks apart. Concurrently with IMRT, patients received a chemotherapy program of lobaplatin 50mg/m(2). Cycle repetition was every 21 days. The IMRT doses were planning target volume (PTV) 68-72 Gy for gross disease in the nasopharynx, and 66-70 Gy for positive lymph nodes in 33 FRACTIONS. The doses for high risk and low risk region PTV were 59.4 Gy in 33 fractions and 50.4 Gy in 28 fractions.

RESULTS

The median follow-up duration was 31 months (range 4-52). The 3-year overall survival (OS) was 74.3%. The 3-year distant metastasis-free survival (DMFS) was 67.4%. The 3-year locoregional relapse-free survival (LRFS) was 91.5%, and the 3-year progression-free survival (PFS) was 61.2%. The efficiency of short-term effects of neoadjuvant chemotherapy and chemoradiotherapy were 83.8% and 100.0%, respectively. Serious acute toxicities observed were neutropenia (97.3%), thrombocytopenia (83.8%) and anemia (81.1%).

CONCLUSIONS

In patients with high-risk N+ NPC, lobaplatin combined with docetaxel neoadjuvant chemotherapy followed by concurrent lobaplatin with IMRT yielded excellent short-term results with mild and tolerable toxicities.