Adjuvant chemotherapy following combined induction chemotherapy and concurrent chemoradiotherapy improves survival in N2-3-positive nasopharyngeal carcinoma patients.

Hao-Yun Tao,Ran Li,Rong-Hui Zheng,Fang He,Kun-Peng Du,Cai-Xian He,Hui Liu,Ya-Wei Yuan

doi:10.1007/s00432-021-03846-6

Abstract

This study aimed to explore the clinical value of adjuvant chemotherapy (ACT) following concurrent chemo-radiotherapy (CCRT) and induction chemotherapy (ICT) in loco-regionally advanced nasopharyngeal carcinoma (LANC). We included839 newly diagnosed LANC patients in this study. ICT plus CCRT (ICT + CCRT group) was administered to 443 patients, and 396 patients received ACT after ICT plus CCRT (ICT + CCRT + ACT group). Univariate and multivariate Cox regression analyses were carried out. Furthermore, propensity score matching (PSM) was applied to balance the study and control groups. A total of 373 pairs of LANC patients were obtained after PSM analysis. We found that ACT following ICT + CCRT has no significant effect on improving the survival of LANC patients. By further exploring the ICT + CCRT + ACT treatment protocol, we excluded N0-1-positive patients and re-performed PSM in the ICT + CCRT and ICT + CCRT + ACT groups. Each group consisted of 237 patients. Kaplan-Meier analysis revealed that there were differences between the ICT + CCRT and ICT + CCRT + ACT groups in terms of the 5-year overall survival (OS) (78.9% vs. 85.0%, P = 0.034), disease-free survival (DFS) (73.4% vs. 81.7%, P = 0.029), and distant metastasis-free survival (DMFS) (84.9% vs. 76.0%, P = 0.019). In addition, the ICT + CCRT + ACT group had a higher incidence of grade 3/4 acute leukocytopenia/neutropenia. Compared with ICT + CCRT, ACT following ICT plus CCRT can reduce distant metastasis of N2-3-positive LANC and improve the OS and DFS. The results demonstrated the feasibility and clinical utility of ACT following ICT plus CCRT.

Highlights

Nasopharyngeal carcinoma (NPC) is endemic in southern Asia, and distant metastasis is the leading cause of mortality[1]
There were 839 patients classified into the induction chemotherapy (ICT) + concurrent chemoradiotherapy (CCRT) and ICT + CCRT + adjuvant chemotherapy (ACT) groups, which comprised 443 and 396 patients, respectively. 746 individuals were enrolled in the study after propensity score matching (PSM), with 373 patients per group
We discovered that ACT following ICT + CCRT had no significant effect on improving the survival of locally advanced NPC patients (LANC) patients

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is endemic in southern Asia, and distant metastasis is the leading cause of mortality[1]. For locally advanced NPC patients (LANC), radiotherapy alone may have a limited effect [3]. The result of the intergroup 0099 study was to demonstrate the clinical value of chemotherapy for patients with LANC [4]. Concurrent chemoradiotherapy (CCRT) increases survival and lowers the incidence of distant metastasis in LANC patients, according to several prospective studies conducted in NPC epidemic regions [5, 6]. Sun et al [7] found that compared to CCRT alone, combining induction chemotherapy (ICT) with CCRT improved 3year failure-free survival (FFS) in LANC patients. ICT followed by definitive CCRT could improve clinical outcomes, but approximately 30% of patients will subsequently develop recurrence and/or distant metastasis [8,9,10,11,12]

Results

Discussion

Conclusion