Is the Neoadjuvant Docetaxel, Cisplatin and 5-Fluorouracil Regimen Superior to Classic Cisplatin and 5-Fluorouracil for Locoregionally Advanced Nasopharyngeal Carcinoma?

 Objectives: We retrospectively compared the toxicity and efficacy of two neoadjuvant chemotherapy regimens (docetaxel+cisplatin+5-fluorouracil vs. cisplatin+5-fluorouracil) followed by chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma. Patients and Materials: We analysed 135 patients with stage III and IVA-B nasopharyngeal carcinoma. Forty-four patients were treated with docetaxel+cisplatin+5-fluorouracil and chemoradiotherapy (TPF group), and 91 were treated with cisplatin+5-fluorouracil and chemoradiotherapy (PF group). Chemoradiotherapy was administered with weekly cisplatin. Radical radiotherapy with total doses of 70-74Gy was administered using a conventional technique, over 7 weeks in 2.0Gy/fraction; boost doses of 6-10Gy were administered in 55.6% patients (n=75) with locally advanced cancer. Results: The median follow-up was 46.5 months (range, 9.8-62.8 months), and the follow-up rate was 95%. The TPF group had better 5-year estimated progression-free survival (77.0% vs. 73.5%; P = 0.510) and overall survival than the PF group (80.7% vs. 77.9%, P = 0.446); however, there was no statistically significant difference between the groups. Toxicities in the two groups were similar; grade 3/4 oral mucositis was more common in the TPF group (27.3%) than in the PF group (15.3%) during chemoradiotherapy. Conclusions: The neoadjuvant docetaxel+cisplatin+5-fluorouracil chemotherapy led to satisfactory long-term survival and slight improvement in progression-free survival and overall survival as compared with the classic cisplatin+5-fluorouracil regimen; toxicity was tolerable. However, prospective trials are needed to prove whether docetaxel+cisplatin+5-fluorouracil is a substitute for cisplatin+5-fluorouracil.