Assessment of Concurrent Chemoradiotherapy plus Induction Chemotherapy in Advanced Nasopharyngeal Carcinoma: Cisplatin, Fluorouracil, and Docetaxel versus Gemcitabine and Cisplatin

Zhen Zeng,Yu-Yi Wang,Pei-Ran Chen,Lei Liu,Ruo-Nan Yan,Li Tu,Feng Luo

doi:10.1038/s41598-018-33614-5

Abstract

Induction chemotherapy treatment for nasopharyngeal carcinoma (NPC) is controversial. The aim of this study was to evaluate the treatment outcomes and toxicities between two induction chemotherapy regimens, with both followed by concurrent chemoradiotherapy. The first strategy used docetaxel, cisplatin and fluorouracil for induction chemotherapy (TPF), and the second utilised gemcitabine and cisplatin (GP). A retrospective analysis was performed on eligible NPC patients attending our hospital between May 2009 and Dec 2014. A total of 113 patients were enrolled with 58 patients receiving TPF and 55 receiving GP induction chemotherapy. Ninety-four patients (83.2%) were alive after 36-months follow-up. The median overall survival (OS) and progression-free survival (PFS) time were 48.3 and 39.7 months, respectively. The 3-year OS for the TPF regimen was 87.9% and 87.4% with GP chemotherapy (P = 0.928). The 3-year PFS of the TPF treatment was 84.5%, while it was 83.5% for the GP group (P = 0.551). Univariate analysis showed that lymph node metastasis was a significant PFS prognostic factor, while N3 stage was an independent predictor of PFS and distant failure-free survival (DMFS) in multivariate analysis. There were no significant differences in adverse toxicities or treatment efficacy between the chemotherapy regimens in the treatment of locoregionally advanced NPC.

Highlights

Characteristic gender male female average age,years T category T1 T2 T3 T4 N category N0 N1 N2 N3 Disease stage III IV
Baseline characteristics are summarised in Table 1. 47 (81%) patients completed three cycles of TPF induction chemotherapy, 11 (19%) received two cycles
Trial 00915 laid the foundation for CCRT treatment in nasopharyngeal carcinoma (NPC)

Summary

Introduction

Characteristic gender male female average age,years T category T1 T2 T3 T4 N category N0 N1 N2 N3 Disease stage III IV. Adding chemotherapy to the treatment of locally advanced NPC has been shown to benefit patients[10]. A phase 3 randomised controlled trial comparing CCRT alone versus induction chemotherapy including docetaxel, cisplatin and fluorouracil (5-FU) (known as TPF) followed by CCRT, demonstrated significant improvements in failure-free survival for patients with locoregionally advanced NPC. Another study reported that gemcitabine and cisplatin (GP) induction chemotherapy demonstrated better overall survival (OS), and improved distant metastasis-free survival (DMFS) to some extent[12]. A phase II study concluded that GP induction chemotherapy with IMRT, was well-tolerated and effective for locoregionally advanced NPC15. In the present study we aim to compare the TPF induction regimen (cisplatin, 5-FU, and docetaxel) with the GP regimen (gemcitabine and cisplatin) in patients with locoregionally advanced NPC, with both treatment groups receiving CCRT

Objectives

Methods

Results

Conclusion