Assessment of tumor size changes following neoadjuvant chemotherapy for patients with N3 nasopharyngeal carcinoma

Objective: Nasopharyngeal cancers are among the most frequent head and neck cancers. Advanced disease at initial presentation is not uncommon partly due to the relatively deep and hidden location of the nasopharyngeal cavity. The most common practice for the management of locally advanced disease includes the administration of concurrent chemoradiotherapy followed by adjuvant chemotherapy, however, the utility of neoadjuvant chemotherapy particularly in the presence of high-risk, advanced nasopharyngeal cancers has also been suggested. Herein, tumor size changes following neoadjuvant chemotherapy for patients with N3 nasopharyngeal cancer is assessed with consideration of clinical implications. Methods: A total of 15 patients with N3 nasopharyngeal carcinoma were assessed. All patients received upfront neoadjuvant chemotherapy and were then referred for definitive chemoradiotherapy at the Department of Radiation Oncology at Balıkesir Atatürk City Hospital, Turkey. For comparative evaluation, tumor sizes were calculated from the diagnostic imaging of the patients at initial presentation and from the CT-simulation images which have been acquired for radiation treatment planning after neoadjuvant chemotherapy. Tumor sizes before and after neoadjuvant chemotherapy were documented. Results: A comparative analysis was performed for tumor sizes at diagnostic imaging at initial presentation and at CT simulation for radiation treatment planning after neoadjuvant chemotherapy, and the mean reduction in tumor size after neoadjuvant chemotherapy was found to be 33%. Conclusion: The result of this study may have clinical implications and the utilized therapeutic strategy including upfront neoadjuvant chemotherapy may be suitable for the management of selected patients with N3 nasopharyngeal cancer despite the need for further supporting evidence