Abstract
BackgroundWe compared the efficacy and toxicity of three IC regimens (TPF: taxanes, cisplatin, and 5-fluorouracil; TP: taxanes and cisplatin; and PF: cisplatin and 5-fluorouracil) followed by CCRT in locoregionally advanced NPC.MethodsThe retrospective study involved 1354 patients with newly diagnosed stage III-IVA NPC treated with IC and CCRT. The median follow-up time in our cohort was 50 months. Based on EBV DNA level, all the patients with stage IV were divided into low- (pre-EBV DNA < 1500 copies) and high-risk group (pre-EBV DNA ≥ 1500 copies). Progression free survival (PFS), overall survival (OS), locoregional relapse free survival (LRFS), distant metastasis free survival (DMFS) and grade 3–4 toxicities were compared among different IC regimens. The survival rates were compared using log-rank test and a Cox proportional hazards model was used to perform multivariate analyses.ResultsA multivariate analysis revealed TPF to be more effective than TP. Among stage III patients, no significant difference in clinical outcome between the different IC regimens was showed, while TPF was associated with significantly better survival conditions in the stage IV patients. A further subgroup analysis revealed that only patients with pre-EBV DNA ≥ 1500 copies could benefit from the application of TPF among stage IV NPC. In terms of acute toxicities, PF was associated with fewer grade 3/4 acute toxicities.ConclusionsIn low-risk NPC patients, PF-based IC showed similar efficacy as TPF and TP but was associated with fewer grade 3/4 acute toxicities. In high-risk patients, however, the TPF regimen was superior to PF and TP, although grade 3/4 toxicities were more common with the TPF regimen.
Highlights
We compared the efficacy and toxicity of three induction chemotherapy (IC) regimens (TPF: taxanes, cisplatin, and 5-fluorouracil; TP: taxanes and cisplatin; and Cisplatin and 5-fuorouracil) (PF): cisplatin and 5-fluorouracil) followed by concurrent chemoradiation therapy (CCRT) in locoregionally advanced Nasopharyngeal carcinoma (NPC)
The eligibility criteria for inclusion were newly diagnosed biopsy-proven NPC; receipt of first-line IC for at least 2 cycles followed by CCRT; Karnofsky performance score (KPS) > 70; adequate organ functions and with available hematological sample and Epstein–Barr Virus (EBV) serology results
Distant metastasis remains a critical issue in cases of advanced NPC [23, 24], and IC could facilitate the eradication of micro-metastatic lesions and reduce locoregional failure
Summary
We compared the efficacy and toxicity of three IC regimens (TPF: taxanes, cisplatin, and 5-fluorouracil; TP: taxanes and cisplatin; and PF: cisplatin and 5-fluorouracil) followed by CCRT in locoregionally advanced NPC. Nasopharyngeal carcinoma (NPC) is a malignant disease arising from the nasopharyngeal epithelium. It is most endemic to Southern China, where 50–80 cases per 100,000 persons are reported each year [1]. The development of modern RT has resulted in improved local control rates for NPC [3,4,5]. The prevention of distant metastasis in advanced NPC remains unsatisfactory and is the main cause of treatment failure [6]. An effective treatment protocol is necessary to achieve better outcomes in these cases
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