Abstract
Neoadjuvant chemotherapy (NAC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) will be the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) patients. However, many patients fail to receive CC for multiple reasons. We aimed to investigate long-term survival outcomes and toxicities in these patients with NPC treated with additional NAC plus concurrent chemoradiotherapy (CCRT) or IMRT alone. In total, 1,378 previously untreated, newly diagnosed locoregionally advanced NPC patients receiving NAC plus IMRT with or without CC were retrospectively reviewed. We used a propensity score-matched (PSM) method with 1:1 matching to identify paired patients according to various covariates. Survival outcomes and toxicities were compared between the two groups. In total, 288 pairs were identified. With a median follow-up of 86 (range: 8–110) months, the estimated 5-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival rates in patients treated with NAC plus CCRT vs. NAC plus IMRT alone were 96.1% vs. 94.7% (P = 0.201), 93.7% vs. 89.8% (P = 0.129), 91.3% vs. 85.1% (P = 0.024), and 93.0% vs. 90.6% (P = 0.362), respectively. Multivariate analysis showed that CC omission was a prognostic factor for worse PFS. In a subgroup analysis, PFS did not differ significantly between two groups of female patients or aged <60 years or stage T1–2 or stage N0-1 disease. However, fewer acute complications were observed in the NAC plus IMRT alone group. NAC with IMRT alone confers similar survival rates and less acute toxicities. Specifically, NAC plus IMRT alone may be enough for female patients <60 years with stage T1-2 or stage N0-1. However, a prospective randomised trial is needed to validate these results.
Highlights
Neoadjuvant chemotherapy (NAC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) will be the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) patients
From May 2008 through April 2014, 1,378 previously untreated patients diagnosed with locoregionally advanced NPC received NAC plus IMRT with or without CC
1078 patients were treated with additional NAC to concurrent chemoradiotherapy (CCRT), and 300 patients received NAC, followed by IMRT alone
Summary
Neoadjuvant chemotherapy (NAC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) will be the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) patients. Concurrent chemoradiotherapy (CCRT) with or without adjuvant chemotherapy (AC) is beneficial in overall survival (OS) and has become the standard treatment for locoregionally advanced NPC, even with the acute toxicities[9,10,11]. A previous meta-analysis showed that when compared with CCRT alone, the addition of neoadjuvant chemotherapy (NAC) before CCRT reduced distant failure in locoregionally advanced NPC patients[12,13]. A phase III randomised study by Xu et al showed that NAC added to IMRT plus AC yielded similar OS and PFS with CCRT plus AC, while with less acute toxicities[20]. We performed a retrospective, matched analysis of locoregionally advanced NPC patients to compare the efficacy and safety of adding NAC to IMRT alone with NAC before CCRT
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