Abstract
The role of induction chemotherapy in nasopharyngeal carcinoma (NPC) remains controversial. The primary aim of this study was to use the National Cancer Database to evaluate the patterns of care of induction chemotherapy in NPC and its impact on overall survival (OS). Patients with NPC from 2004 to 2014 were obtained from the NCDB. Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT and concurrent CRT if chemotherapy started within 21 days after the start of RT. Propensity score matching was used to control for selection bias. Cox proportional hazards model was used to determine significant predictors of OS. Logistic regression model was used to determine predictors of the use of induction chemotherapy. Significance was defined as a P value <.05. A total of 4857 patients were identified: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy. The use of induction therapy remained stable between 2004 and 2014. Younger patients and those with higher T‐ and N‐stage had a higher likelihood of being treated with induction chemotherapy. The 5‐year OS in patients treated with induction chemotherapy and CRT was 66.3% vs 69.1%, respectively (P = .25). There was no difference in OS when these two groups were analyzed after propensity score matching. No differences in OS existed between these treatment groups in patients with T3‐T4N1 or TanyN2‐3 disease (P = .76). Propensity score matching also did not reveal any difference in OS in patients with T3‐T4N1 or TanyN2‐3 disease. The use of induction chemotherapy has remained stable in the last decade. In this study of patients with NPC, induction chemotherapy was not associated with improved OS compared to CRT alone.
Highlights
Nasopharyngeal carcinoma (NPC) accounts for approximately 3000 new cases in the United States each year and approximately 80 000 new cases worldwide, with the majority of them diagnosed in Southeast and Eastern Asia, and Northern Africa.[1]
Patients were considered to have received concurrent CRT if chemotherapy started within 21 days after the start of radiation therapy (RT) as this would allow for overlap of at least 2-3 cycles of concurrent chemotherapy with RT
A total of 4857 patients were included in the analysis based on the previously mentioned selection criteria: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy (Table 1)
Summary
Nasopharyngeal carcinoma (NPC) accounts for approximately 3000 new cases in the United States each year and approximately 80 000 new cases worldwide, with the majority of them diagnosed in Southeast and Eastern Asia, and Northern Africa.[1]. Prior to the advent of megavoltage RT, NPC had a poor prognosis; modern RT technology, especially Intensity Modulated RT, and concurrent chemotherapy has resulted in >70% 5-y ear overall survival.[2,3,4,5]. Several studies in the early 1990s and 2000s demonstrated that concurrent chemoradiation (CRT) followed by adjuvant cisplatin improved survival compared to RT alone and established this as the standard of care for newly diagnosed NPC.[2,5] the use of 3-d imensional imaging (CT and MRI) along with improvement in RT technology has resulted in excellent local control rates.[6] distant failure still remains the main source of mortality in this patient population. There is a notion that additional chemotherapy, either in the form of induction therapy or adjuvant therapy, may improve distant control, especially in patients with locally advanced disease, resulting in an improved overall survival
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