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The aim of this study was to determine the efficacy and toxicity of combination paclitaxel and carboplatin chemotherapy in patients with metastatic and/or locoregionally advanced nasopharyngeal carcinoma (NPC). Patients with metastatic and/or locoregionally advanced NPC were treated with carboplatin calculated according to an AUC of 6 mg ml/min (based on Calvert formula) given as an intravenous (i.v.) bolus, followed by paclitaxel 135 mg/ml2 given as an i.v. infusion over 3 h with standard premedication. Cycles were given 3 weekly to a maximum of six. From January 1996 to November 1997, 27 patients were entered and assessable for response and toxicity. A total of 122 cycles were given and the median number of cycles given was five. The overall response rate was 59% (16/27). There were 3 (11%) complete responses, 13 (48%) partial responses, 5 (19%) static disease and 6 (22%) progressive disease. Toxicity was mainly haematological including: grade 3/4 neutropenia (39 cycles, 32%), grade 3/4 anaemia (nine cycles, 7%), grade 3/4 thrombocytopenia (eight cycles, 7%). There were three episodes of neutropenic fever (3%). Non-haematological toxicities were mild and infrequent. Paclitaxel and carboplatin combination chemotherapy is active in NPC and has tolerable toxicity. Further study with dose escalation is required to assess its optimal efficacy.

DOCETAXEL IS a member of the taxane group of chemotherapeutic agents that cause disruption of cell division by enhancing microtubule assembly and inhibiting tubulin depolymerisation. It has been reported to show promising results in the treatment of metastatic breast cancer [l]. We report a particularly striking case of radiation-recall dermatitis, the first to be associated with docetaxel, and the first in which a threshold for the radiation dose could be clearly established. A 51 year-old woman was initially diagnosed to have carcinoma of the right breast in 1992. She underwent modified radical mastectomy and axillary dissection followed by adjuvant tamoxifen therapy. She remained well until December 1995 when she was found to have liver metastases for which she received weekly intravenous 5-fluorouracil whilst continuing with tamoxifen. In January 1996 she was referred to our institute for further management. Bone scintigraphy showed metastases in the skull, at multiple levels of the spine, in multiple ribs, the bony pelvis and both scapulae and femori. As her main symptom was severe bone pain, mainly involving the lower spinal and pelvic areas, she was given palliative radiotherapy to the spine and pelvis. Over a lo-day period from January 23 (day l), she received 30 Gy in 10 fractions to the TlO-L4 spine and pelvis. Photons (6 MeV) from a linear accelerator was given to the patient in a prone position (Figure la). The spine was treated by a single posterior field. The skin dose at the back and front were 8.7 Gy and 18.7 Gy, respectively. The pelvis was treated by a pair of anterior-posterior opposing fields and the skin dose at the back and front were 16.8 Gy and 21.5 Gy, respectively. The difference in dose was due to the presence of a thin perspex support apposing the skin at the front. During this time, she suffered mild nausea and vomiting, and developed severe diarrhoea from day 13 to day 24, which