Efficacy of Concurrent Chemotherapy for Intermediate Risk NPC in the Intensity-Modulated Radiotherapy Era: a Propensity-Matched Analysis.

Ying Sun,Fan Zhang,Lei Chen,Rui Guo,Jun Ma,Wen-Fei Li,Yuan Zhang,Ai-Hua Lin,Xu Liu

doi:10.1038/srep17378

Abstract

This study is to evaluate the efficacy of additional concurrent chemotherapy for intermediate risk (stage II and T3N0M0) NPC patients treated with intensity-modulated radiotherapy (IMRT).440 patients with intermediate risk NPC were studied retrospectively, including 128 patients treated with IMRT alone [radiotherapy group (RT group)] and 312 paitents treated with IMRT plus concurrent chemotherapy [chemoradiotherapy group (CRT group)]. Propensity score matching was carried out to create RT and CRT cohorts equally matched for host and tumor factor. Significantly more severe acute toxicities were observed in the CRT group than in the RT group. Multivariate analyses of 440 patients failed to demonstrate concurrent chemotherapy as an independent prognostic factor for FFS, LR-FFS, and D-FFS. Between the well-matched RT cohort and the CRT cohort, no significant difference was demonstrated in all survival endpoints (FFS: 92.8% versus 91.2%, P = 0.801; LR-FFS: 95.2% versus 94.4%, P = 0.755; D-FFS: 96.4% versus 96.3%, P = 0.803; OS: 98.2% versus 98.9%, P = 0.276). Our results demonstrated that for patients with intermediate risk NPC treated with IMRT, additional concurrent chemotherapy did not provide any significant survival benefit but significantly more severe acute toxicities. However, prospective randomized trials are warranted for the ultimate confirm of our findings.

Highlights

Nasopharyngeal carcinoma (NPC) is an endemic disease in south China and a highly chemoradiosensitive tumor
Our team conducted a large-sample retrospective study to evaluate the efficacy of additional concurrent chemotherapy for intermediate risk NPC treated with intensity-modulated radiotherapy (IMRT) in our center in an endemic area
We found that additional concurrent chemotherapy failed to result in significant differences in the four subgroups for all endpoints examined (Table 4)

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is an endemic disease in south China and a highly chemoradiosensitive tumor. There has been one randomized trial[3] performed in the stage II population that demonstrated improvement in distant control and overall survival (OS) after the addition of concurrent chemotherapy. As one of the key milestones in the management of NPC, intensity-modulated radiotherapy (IMRT) offers improved tumor target conformity, higher dose to the target, superior radiobiological effect of accelerated fractionation, and better protection of normal organ at risk[7,8]; it has gradually replaced 2DCRT and changed the treatment modality of NPC. We included stage II and T3N0M0 disease as intermediate risk NPC in the era of IMRT in our study. Our team conducted a large-sample retrospective study to evaluate the efficacy of additional concurrent chemotherapy for intermediate risk NPC treated with IMRT in our center in an endemic area

Methods

Results

Conclusion