High Complete Response in Advanced Nasopharyngeal Carcinoma With Bleomycin, Epirubicin, and Cisplatin Before Radiotherapy
Identifieur interne : 000475 ( France/Analysis ); précédent : 000474; suivant : 000476High Complete Response in Advanced Nasopharyngeal Carcinoma With Bleomycin, Epirubicin, and Cisplatin Before Radiotherapy
Auteurs : Mounir Bachouchi [France] ; Esteban Cvitkovic [France] ; Nasser Azli [Algérie] ; Jamal Gasmi [France] ; Hernan Cortes-Funes [Espagne] ; Hamouda Boussen [Tunisie] ; Mohamed Rahal [Algérie] ; Chantal Kalifa [France] ; Guy Schwaab [France] ; Francois Eschwege [France] ; Pierre Wibault [France] ; Jean Pierre Armand [France]Source :
- JNCI: Journal of the National Cancer Institute [ 0027-8874 ] ; 1990-04-04.
Abstract
Undifferentiated carcinoma of nasopharyngeal type (UCNT) is a geographically endemic, Epstein-Barr virus-related carcinoma of epidermoid origin with reported 5-year survival rates of 15%–40% when treated with radiotherapy alone. Although UCNT can be well controlled locally by radiation therapy, in advanced nodal stage N3 [International Union Against Cancer-American Joint Committee on Cancer (UICC-AJCC, 1987)] the survival rate is below 20%, primarily because of metastatic spread in 80% of the fatalities. We report a pilot study of 41 patients with nonmetastatic, locoregionally advanced disease (85% of the patients had a nodal status ≥ N2C-N3; 43% had T4 primaries), during which we used a combination of 100 mg of cisplatin/m2 on day 1, 15 mg of bleomycin by intravenous push and 12 mg/m2 by continuous infusion on days 1–5, and 70 mg of epirubicin/m2 on day 1 every 21 days for three cycles before definitive radiation therapy with 70 Gy for 7 weeks. Twenty-seven of 41 patients (66%; 95% confidence interval = 52.5%–80.5%) achieved a clinical complete response, and 40 of 41 (98%) had a major objective response after chemotherapy. Two deaths were treatment related, but side effects were moderate, and the overall treatment sequence was feasible. At the end of radiation therapy, all 39 assessable patients were in complete response, with a median follow-up of 21+ months (>10–>31); 33 (80%) patients had no evidence of disease. We believe that such a complete response rate in a high-volume disease with the use of combined modality treatment indicates a therapeutic gain in UCNT. Researchers performing a multicenter international controlled trial will test this hypothesis and compare local control, disease-free, and overall survival of the therapeutic sequence presented here with radiotherapy alone. (J Natl Cancer Inst 82:616–620, 1990)
Url:
DOI: 10.1093/jnci/82.7.616
Affiliations:
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uniqKey="Cvitkovic E" first="Esteban" last="Cvitkovic">Esteban Cvitkovic</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Department of Medicine Institut Gustave Roussy Villejuif</wicri:regionArea></affiliation></author><author><name sortKey="Azli, Nasser" sort="Azli, Nasser" uniqKey="Azli N" first="Nasser" last="Azli">Nasser Azli</name><affiliation wicri:level="1"><country xml:lang="fr">Algérie</country><wicri:regionArea>Department of Oncology, Benbadis Hospital Constantine</wicri:regionArea><wicri:noRegion>Benbadis Hospital Constantine</wicri:noRegion></affiliation></author><author><name sortKey="Gasmi, Jamal" sort="Gasmi, Jamal" uniqKey="Gasmi J" first="Jamal" last="Gasmi">Jamal Gasmi</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Department of Medicine Institut Gustave Roussy Villejuif</wicri:regionArea></affiliation></author><author><name sortKey="Cortes Funes, Hernan" sort="Cortes Funes, 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Radiotherapy, Institut Gustave Roussy Villejuif</wicri:regionArea><wicri:noRegion>Institut Gustave Roussy Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Wibault, Pierre" sort="Wibault, Pierre" uniqKey="Wibault P" first="Pierre" last="Wibault">Pierre Wibault</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Department of Radiotherapy, Institut Gustave Roussy Villejuif</wicri:regionArea><wicri:noRegion>Institut Gustave Roussy Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Armand, Jean Pierre" sort="Armand, Jean Pierre" uniqKey="Armand J" first="Jean Pierre" last="Armand">Jean Pierre Armand</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Department of Medicine Institut Gustave Roussy Villejuif</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">JNCI: Journal of the National Cancer Institute</title><idno type="ISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="1990-04-04">1990-04-04</date><biblScope unit="volume">82</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="616">616</biblScope><biblScope unit="page" to="620">620</biblScope></imprint><idno type="ISSN">0027-8874</idno></series><idno type="istex">BFC6EF0059723D8C6F7E376D52500A8C2E00C787</idno><idno type="DOI">10.1093/jnci/82.7.616</idno><idno type="ArticleID">82.7.616</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0027-8874</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Undifferentiated carcinoma of nasopharyngeal type (UCNT) is a geographically endemic, Epstein-Barr virus-related carcinoma of epidermoid origin with reported 5-year survival rates of 15%–40% when treated with radiotherapy alone. Although UCNT can be well controlled locally by radiation therapy, in advanced nodal stage N3 [International Union Against Cancer-American Joint Committee on Cancer (UICC-AJCC, 1987)] the survival rate is below 20%, primarily because of metastatic spread in 80% of the fatalities. We report a pilot study of 41 patients with nonmetastatic, locoregionally advanced disease (85% of the patients had a nodal status ≥ N2C-N3; 43% had T4 primaries), during which we used a combination of 100 mg of cisplatin/m2 on day 1, 15 mg of bleomycin by intravenous push and 12 mg/m2 by continuous infusion on days 1–5, and 70 mg of epirubicin/m2 on day 1 every 21 days for three cycles before definitive radiation therapy with 70 Gy for 7 weeks. Twenty-seven of 41 patients (66%; 95% confidence interval = 52.5%–80.5%) achieved a clinical complete response, and 40 of 41 (98%) had a major objective response after chemotherapy. Two deaths were treatment related, but side effects were moderate, and the overall treatment sequence was feasible. At the end of radiation therapy, all 39 assessable patients were in complete response, with a median follow-up of 21+ months (>10–>31); 33 (80%) patients had no evidence of disease. We believe that such a complete response rate in a high-volume disease with the use of combined modality treatment indicates a therapeutic gain in UCNT. Researchers performing a multicenter international controlled trial will test this hypothesis and compare local control, disease-free, and overall survival of the therapeutic sequence presented here with radiotherapy alone. (J Natl Cancer Inst 82:616–620, 1990)</div></front></TEI><affiliations><list><country><li>Algérie</li><li>Espagne</li><li>France</li><li>Tunisie</li></country><region><li>Île-de-France</li></region><settlement><li>Savigny-le-Temple</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Bachouchi, Mounir" sort="Bachouchi, Mounir" uniqKey="Bachouchi M" first="Mounir" last="Bachouchi">Mounir Bachouchi</name></noRegion><name sortKey="Armand, Jean Pierre" sort="Armand, Jean Pierre" uniqKey="Armand J" first="Jean Pierre" last="Armand">Jean Pierre Armand</name><name sortKey="Bachouchi, Mounir" sort="Bachouchi, Mounir" uniqKey="Bachouchi M" first="Mounir" last="Bachouchi">Mounir Bachouchi</name><name sortKey="Cvitkovic, Esteban" sort="Cvitkovic, Esteban" uniqKey="Cvitkovic E" first="Esteban" last="Cvitkovic">Esteban Cvitkovic</name><name sortKey="Eschwege, Francois" sort="Eschwege, Francois" uniqKey="Eschwege F" first="Francois" last="Eschwege">Francois Eschwege</name><name sortKey="Gasmi, Jamal" sort="Gasmi, Jamal" uniqKey="Gasmi J" first="Jamal" last="Gasmi">Jamal Gasmi</name><name sortKey="Kalifa, Chantal" sort="Kalifa, Chantal" uniqKey="Kalifa C" first="Chantal" last="Kalifa">Chantal Kalifa</name><name sortKey="Schwaab, Guy" sort="Schwaab, Guy" uniqKey="Schwaab G" first="Guy" last="Schwaab">Guy Schwaab</name><name sortKey="Wibault, Pierre" sort="Wibault, Pierre" uniqKey="Wibault P" first="Pierre" last="Wibault">Pierre Wibault</name></country><country name="Algérie"><noRegion><name sortKey="Azli, Nasser" sort="Azli, Nasser" uniqKey="Azli N" first="Nasser" last="Azli">Nasser Azli</name></noRegion><name sortKey="Rahal, Mohamed" sort="Rahal, Mohamed" uniqKey="Rahal M" first="Mohamed" last="Rahal">Mohamed Rahal</name></country><country name="Espagne"><noRegion><name sortKey="Cortes Funes, Hernan" sort="Cortes Funes, Hernan" uniqKey="Cortes Funes H" first="Hernan" last="Cortes-Funes">Hernan Cortes-Funes</name></noRegion></country><country name="Tunisie"><noRegion><name sortKey="Boussen, Hamouda" sort="Boussen, Hamouda" uniqKey="Boussen H" first="Hamouda" last="Boussen">Hamouda Boussen</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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