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.

Objective: 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.