A Comparative Study of Radiotherapy Alone and Concurrent Chemoradiation using Cisplatin as Radiosensitizer in Stage 3 and Stage 4 Nasopharyngeal Carcinoma in an Institute

Introduction Nasopharyngeal carcinoma is the most common nasopharyngeal malignancy. It is more common in males with the age-standardised male-female ratio between 2-3 1. Radiotherapy (RT) has been the mainstay of treatment for NPC and leads to high 5 year overall and disease-free survival rates in early-stage disease. However, there are significant rates of local failure and distant metastasis subsequent to radiotherapy in the advanced stage of disease at which most NPC patient presents. Chemotherapy can achieve long-term survival rates of up to 15 % to 20 %, even in patients with recurrent or metastatic disease. Combining chemotherapy with radiotherapy improve local control, disease free and overall survival and decreases systemic metastasis in locally advanced stage III and IV nasopharyngeal carcinoma. Methods and material A total of 68 patients diagnosed as stage III and IV nasopharyngeal carcinoma were studied. They were grouped into two arms Arm A and Arm B. Arm A constituted 32 patients who were treated with radiation alone. And Arm B constituted 36 patients and they were treated with concurrent chemoradiation using Cisplatin as radiosensitiser. The treatment responses and the weekly assessment of toxicities were compared between the two arms. Results Among the total of 68 cases, male female ratio was 1.7 1, and the age range was 26-78 years with the mean age of 48.3811.87 years. The toxicities of treatment i. e. mucositis, skin reactions, anaemia and nausea/vomiting developed earlier in Arm B compared to Arm A. The severity in terms of grade of toxicities was also more in Arm B. Arm B showed better overall treatment response. There was no case of progressive disease in any of the Arms. After 1 month follow-up, around 50 % of those patients persisting with these symptoms at the end of treatment were recovered. Conclusion Concurrent chemoradiation is opted a better treatment for stage III and IV nasopharyngeal carcinoma, as overall treatment response is better compared to radiation alone. Even though treatment-related toxicities are seen higher in concurrent chemoradiation, it is well tolerated and acceptable, and is never life-threatening.