Comparative Analysis of Clinical Results of Compared With TPF Induction of Chemotherapy and PF Adjuvant Chemotherapy Combined With Cisplatin Radiochemotherapy for Locally Advanced Nasopharyngeal Carcinoma

Abstract

<h3>Purpose/Objective(s)</h3> The effect on immediate effect, acute toxicity, lymphocyte immune function and EBVDNA clearance rate in patients with locally advanced nasopharyngeal carcinoma treated by TPF induction chemotherapy combined with cisplatin concurrent radiochemotherapy or PF adjuvant chemotherapy combined with cisplatin concurrent radiochemotherapy (these two therapeutic regimens fall under Class 2A evidence in the 2019 NCCN guideline) is investigated to seek a treatment method with high-efficiency and low-toxicity or equivalent and low-toxicity. <h3>Materials/Methods</h3> Seventy-two patients diagnosed with locally advanced nasopharyngeal carcinoma from June 2018 to September 2019 were randomly divided into two groups - the TPF induction chemotherapy (experimental group) and the PF adjuvant chemotherapy (control group). The experimental group was treated with 3 cycles of TPF induction chemotherapy + cisplatin concurrent radiochemotherapy, while the control group received cisplatin concurrent radiochemotherapy + 3 cycles of PF adjuvant chemotherapy. <h3>Results</h3> In the aspect of the immediate effect, both groups had a high effective rate (CR+PR)% (91.9% vs. 93.9%, χ² value = 0.740, <i>P</i> > 0.05). The CR% of the control group was superior to that of the experimental group (54.5% vs. 18.9%, χ² value = 9.643, <i>P</i> < 0.05). In terms of acute toxicities, the incidence of side effects like white blood cells, neutrophils, and diarrhea in the experimental group was higher than those in the control group, with the difference statistically significant (<i>P</i> < 0.05), while there was no statistical difference in the incidence of hemoglobin, platelets, ALT/AST, nausea, vomiting, constipation and oral mucositis between the two groups (<i>P</i> > 0.05). The experimental group prevailed over the control group in CD4+/CD8+ and CD4+, while CD4+ was statistically different between the two groups (<i>P</i> < 0.05). After treatment, the comparison of the EBVDNA clearance rate in EBVDNA-positive patients before treatment in two groups showed that EBVDNA clearance of the experimental group was more effective than that of the control group (68.8% vs. 54.2%, χ² value = 1.244, <i>P</i> > 0.05), and upon treatment, compared with the clearance of EBVDNA positive high expression before treatment in both groups, the experimental group also had a higher trend (63.6% vs. 37.5%, χ² value = 1.269, <i>P</i> > 0.05), but the difference was not statistically significant in two groups. <h3>Conclusion</h3> The two groups possessed the same immediate effective rate (CR+PR) %. The PF adjuvant group had less acute toxicity, while the TPF induction group had a better trend in improving lymphocyte immune function and EBVDNA clearance.