Induction chemotherapy followed by concurrent chemoradiotherapy is benefit for advanced stage nasopharyngeal carcinoma with different nonkeratinizing carcinoma subtypes

Jian Zang,Jianhua Wang,Man Xu,Shanquan Luo,Xiaowei Kang,Wanni Xu,Chen Li,Mei Shi

doi:10.1038/s41598-018-31050-z

Abstract

Given the potentially distinctive histological variations in northwest of China, the aim of current study was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy (IC + CCRT) with concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients with different histological types. A total of 301 patients were included in this study. Patients were classified in two cohorts according to the 2005 WHO World Health Organization histological classification: WHO type IIa group and WHO type IIb group. The Kaplan-Meier method was used to detect the efficacy between IC + CCRT and CCRT in two WHO types cohorts. Propensity score matching method was adopted to balance the baseline covariate and eliminate potential selection bias. On propensity matched analyses, IC + CCRT was found to produce better 3-year DMFS and OS than CCRT in WHO type IIa cohort (DMFS, 76.2% vs. 42.2%, p = 0.029; OS, 78.3% vs. 65.5%, p = 0.027). For WHO type IIb cohort, IC + CCRT was associated with a better 3-year OS (87.4% vs. 77.9%, p = 0.029) and a trend of better 3-year DMFS (85.9% vs. 76%, p = 0.162) compared with CCRT. IC + CCRT was benefit for advanced stage nasopharyngeal carcinoma with different nonkeratinizing carcinoma subtypes.

Highlights

Nasopharyngeal carcinoma (NPC) is an unbalanced geographic distribution disease
In the era of intensity modulated radiotherapy (IMRT), 5-year local recurrence-free survival (LRFS) of locoregionally advanced stage nasopharyngeal carcinoma (NPC) has achieved more than 90%, whereas 5-year distant metastasis-free survival (DMFS) and overall survival (OS) are limited to70–80%11
Compared with Concurrent chemoradiotherapy (CCRT), induction chemotherapy followed by concurrent chemoradiotherapy (IC + CCRT) was identified to be benefit to improve the 3-year DMFS and OS by another phase III randomized study from endemic region of China[14]

Summary

Materials and Methods

We reviewed 524 cases of histologically proven NPC patients, who received initial treatment at our institute between January 2006 to December 2014. The inclusion criteria were as follow: histologically confirmed non-keratinizing carcinoma of nasopharynx by biopsy; locoregionally advanced stage III-IVB without metastasis; receiving IC + CCRT or CCRT as initial treatment modality; receiving IMRT as definitive radiotherapy; patients’ primary residences limited to the northwest of China. The ethics committee of our hospital confirmed it was not necessary to obtain informed consent in this study because there were no participants involved during the research process. All research materials were obtained on the base of the computerized patient record system of xijing hospital. Propensity scores were computed by logistic regression for each patient using the following covariates: age, gender, smoking, drinking, race, blood EBV DNA copies, T category, N category, clinical stage, histological WHO type, tumor volume.

Results

Discussion

Conclusion