Abstract
PurposeTo evaluate the efficacy and safety of induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) versus CCRT combined with adjuvant chemotherapy (AC) in patients with stage II–IVA nasopharyngeal carcinoma (NPC), we conducted a retrospective study and a meta-analysis combining the results of our studies.Patients and MethodsWe used the propensity score matching (PSM) to balance variables. A total of 168 patients were chosen by one-to-two PSM, including 101 patients with IC + CCRT and 67 cases with CCRT + AC. We used the Kaplan–Meier curve to compare survival outcomes and also used Cox regression analysis to determine independent prognostic factors. For meta-analysis, we determined the related studies by searching the PubMed database. We used STATA v12 software to perform meta-analysis of the extracted data and calculate pooled hazard ratios, 95% confidence intervals of survival outcomes, and risk ratios for the toxicities.ResultsIn this retrospective study, there was no significant difference in 5-year overall survival (76.9% vs. 79.0%, P = 0.966), progression-free survival (71.3% vs. 68.5%, P = 0.332), distant metastasis-free survival (80.5% vs. 74.2%, P = 0.140), and locoregional relapse-free survival (91.5% vs. 91.8%, P = 0.894) among patients with NPC with IC + CCRT versus CCRT + AC after PSM. For meta-analysis, six articles (including our study) reporting 1,052 cases of IC + CCRT and 883 cases of CCRT + AC were included in the meta-analysis. There was no difference of OS (pooled HR = 0.90, 95% CI: 0.63–1.29, P = 0.561), PFS (pooled HR = 1.07, 95% CI: 0.87–1.33, P = 0.633), DMFS (pooled HR= 0.98, 95% CI: 0.76-1.25, P=0.861), and LRRFS (pooled HR = 1.06, 95% CI: 0.76–1.48, P = 0.724).ConclusionThe efficacy of IC + CCRT and CCRT + AC was comparable in patients with stage II–IVA NPC. In terms of compliance and acute adverse reactions, IC + CCRT may be a potential therapeutic strategy.
Highlights
Nasopharyngeal carcinoma (NPC) is a malignant tumor of the head and neck with a distinct geographic distribution
There is no doubt that the rate of local control of advanced NPC has improved with the advent of intensitymodulated radiotherapy (IMRT)
3.1.1 Patient Characteristics From November 2011 to December 2015, we identified 364 patients with NPC receiving either induction chemotherapy (IC) + CCRT or CCRT + adjuvant chemotherapy (AC)
Summary
Nasopharyngeal carcinoma (NPC) is a malignant tumor of the head and neck with a distinct geographic distribution. Due to the special location of the nasopharynx and the radiosensitive behavior of NPC cells, radiotherapy has become its main treatment. There is no doubt that the rate of local control of advanced NPC has improved with the advent of intensitymodulated radiotherapy (IMRT). Despite the use of concurrent chemotherapy, distant metastasis and recurrence remain its main mode of treatment failure [4], occurring in 18% to 27% of patients [5]. The Intergroup 0099 Study [6] first established the role and place of chemotherapy in locoregionally advanced NPC (LA-NPC). The addition of chemotherapy, such as induction chemotherapy (IC) and adjuvant chemotherapy (AC), to radiotherapy (RT) may be able to reduce treatment failure due to distant metastases [7]. There are a few research studies and trials comparing the efficacy and safety between IC + CCRT and CCRT + AC, there is still a lack of largescale clinical studies comparing the survival and prognosis of the two treatment modalities
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