Abstract
Background/ObjectiveWe aimed to compare the 10-year survival outcomes of induction docetaxel plus cisplatin and 5-fluorouracil (TPF), docetaxel plus cisplatin (TP), and cisplatin plus 5-fluorouracil (PF) regimens additional to concurrent chemoradiotherapy (CRT) in locoregionally advanced nasopharyngeal carcinoma (NPC).MethodsEligible patients with newly diagnosed stage III-IVA NPC were included. Propensity score matching (PSM) was used to balance prognostic covariates. Survival outcomes and toxicities between different groups were compared.ResultsA total of 855 patients between 2009 and 2012 were included, with 395 (46.2%), 258 (30.2%), and 202 (23.6%) receiving TPF plus CRT, TP plus CRT, and PF plus CRT regimens, respectively. After a median follow-up of 111.8 months, multivariate analysis both in the whole cohort and PSM selected 202 pairs showed that TPF plus CRT and TP plus CRT achieved significantly better 10-year overall survival (OS) than PF plus CRT. Sensitivity analysis after excluding patients with T3-4N0 disease demonstrated that TPF plus CRT still achieved significantly better OS than PF plus CRT (HR, 0.580; 95% CI, 0.395-0.852; P = 0.005), while the difference between TP plus CRT and PF plus CRT was marginally significant (HR, 0.712; 95% CI, 0.503-1.008; P = 0.056). With regard to toxicity profile, PF regimen achieved the lowest grade 3–5 toxicities (27.3%).ConclusionTPF plus CRT and TP plus CRT were better than PF plus CRT in improving the 10-year OS of patients with stage III-IVA NPC.
Highlights
As an aggressive and relatively rare head and neck cancer, nasopharyngeal carcinoma (NPC) has an extremely unbalanced geographical distribution worldwide; it is endemic in Southern China and Southeast Asia but very rare in western countries [1, 2]
After a median follow-up of 111.8 months, multivariate analysis both in the whole cohort and Propensity score matching (PSM) selected 202 pairs showed that TPF plus CRT and than docetaxel plus cisplatin (TP) plus CRT achieved significantly better 10-year overall survival (OS) than plus 5-fluorouracil (PF) plus CRT
Sensitivity analysis after excluding patients with T3-4N0 disease demonstrated that TPF plus CRT still achieved significantly better OS than PF plus CRT (HR, 0.580; 95% confidence intervals (CIs), 0.395-0.852; P = 0.005), while the difference between TP plus CRT and PF plus CRT was marginally significant (HR, 0.712; 95% CI, 0.503-1.008; P = 0.056)
Summary
As an aggressive and relatively rare head and neck cancer, nasopharyngeal carcinoma (NPC) has an extremely unbalanced geographical distribution worldwide; it is endemic in Southern China and Southeast Asia but very rare in western countries [1, 2]. How to reduce distant metastasis and improve the therapeutic outcomes of patients with advanced disease have been widely studied. Several phase III clinical trials conducted in recent years have showed that IC additional to concurrent chemoradiotherapy (CRT) could improve both distant metastasis-free survival (DMFS) and OS [5,6,7,8,9]. This evidence strengthened the role of IC in locoregionally advanced NPC, and IC plus CRT was approved as the preferable treatment strategy worldwide for advanced NPC. The insufficient follow-up duration (median, 46.1 months) and inclusion of patients who did not receive concurrent chemotherapy made these results inconclusive
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