A multicenter, prospective, randomized study of intensity-modulated radiotherapy combined with different chemotherapy regimens for locally advanced nasopharyngeal carcinoma

Abstract

Objective To evaluate the efficacy and toxicity of induction chemotherapy with nedaplatin and docetaxel plus concurrent intensity-modulated radiotherapy(IMRT)with nedaplatin or cisplatin in the treatment of locally advanced nasopharyngeal carcinoma(NPC). Methods A total of 223 patients with pathologically diagnosed locally advanced NPC in five treatment centers from 2011 to 2012 were randomly divided into two groups. In the test group, one hundred and thirteen patients received two cycles of induction chemotherapy with docetaxel(65 mg/m2 on day 1)and nedaplatin(80 mg/m2 on day 1)plus concurrent IMRT with nedaplatin(40 mg/m2 on day 1). In the control group, 110 patients received two cycles of induction chemotherapy with the same regimens plus concurrent IMRT with cisplatin(40 mg/m2 on day 1). The survival rates were calculated with the Kaplan-Meier method and the differences in the survival rates between the two groups were analyzed using the log-rank test. Comparison of the incidence rates of adverse reactions between the two groups was made by the chi-square test. Results The follow-up rate was 99. 1%.The response rates at 3 months after treatment in the two groups were both 100%. The 2-year local recurrence-free, regional recurrence-free, distant metastasis-free, and overall survival rates were 94. 0%, 94.2%, 88.2%, and 90. 3%, respectively, in the test group, versus 93.4%, 94. 1%, 86. 7%, and 87. 3% in the control group(P=0. 757、0. 478、0. 509、0. 413). The incidence rates and severity of leucopenia, neutropenia, and thrombocytopenia were significantly higher in the test group than in the control group(P=0. 027, 0. 028, 0. 035). The incidence rates and severity of hemoglobin reduction and nausea / vomiting were significantly lower in the test group than in the control group(P = 0. 000,0. 023). There were no significant differences in the incidence rates of mucositis and xerostomia between the two groups(P= 0.483,0.781). Conclusions The short-term efficacy of induction chemotherapy with nedaplatin and docetaxel plus concurrent IMRT with nedaplatin is similar to that with cisplatin in the treatment of locally advanced NPC. The mild gastrointestinal reactions can be tolerated by patients. However, the severe myelosuppression should be closely monitored during the treatment. Key words: Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Nasopharyngeal neoplasms/chemotherapy; Induction chemotherapy; Concurrent chemoradiotherapy; Prognosis