Abstract
BackgroundThe relative efficacy of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) versus IC followed by radiotherapy (RT) alone in locoregionally advanced NPC remains unclear.MethodsA total of 877 patients with locally advanced NPC who underwent IC/CCRT or IC/RT at four institutions in China between January 2004 and December 2010 were retrospectively assessed. IC was cisplatin-based combination chemotherapy; concurrent chemotherapy, single agent cisplatin. Two-dimensional conventional radiotherapy (2DCRT) was the radiotherapy technique. All patients were matched in an equal ratio using a pair-matched method. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRRFS) and toxicities were assessed.ResultsEligible patients were matched (n = 642; 321 patients per arm) based on eight clinicopathological characteristics. Five-year OS, DFS, DMFS, and LRRFS were 76%, 70%, 86%, and 88% for IC/CCRT and 75%, 70%, 90%, and 91% for IC/RT, respectively. There were no statistically significant survival differences between arms (P>0.05), even in subgroup analysis. In multivariate analysis, treatment (IC/CCRT vs. IC/RT) was not an independent prognostic factor for any survival end-point. Grade 3/4 acute gastrointestinal toxicities (vomiting, nausea) and hematological toxicities (leucopenia/neutropenia, thrombocytopenia and anemia) were significantly more common in the IC/CCRT arm than IC/RT arm during RT.ConclusionOverall, IC/CCRT failed to demonstrate any survival advantage but higher acute toxicities over IC/RT in locoregionally advanced NPC.
Highlights
Nasopharyngeal carcinoma (NPC) is an endemic malignant tumor that is highly prevalent in a number of regions, including southeast Asia and southern China [1]
The clinical data of the 877 patients with advanced NPC treated between January 2004 and December 2010 who met all of the criteria was registered
After matching based on eight clinicopathological characteristics, a total of 642 patients were included in this study: 321 received induction chemotherapy (IC) followed by RT alone and 321 received IC plus concurrent chemoradiotherapy (CCRT)
Summary
Nasopharyngeal carcinoma (NPC) is an endemic malignant tumor that is highly prevalent in a number of regions, including southeast Asia and southern China [1] As it is highly chemo- and radiosensitive, chemotherapy in combination with radiotherapy (RT) has become the standard recommended treatment in the NCCN guidelines for locoregionally advanced NPC [2]. Numerous studies have demonstrated that induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) represents an effective approach to significantly improve survival in locoregionally advanced NPC [3, 4]. This strategy is www.impactjournals.com/oncotarget widely applied in the areas of China where NPC is endemic. The relative efficacy of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) versus IC followed by radiotherapy (RT) alone in locoregionally advanced NPC remains unclear
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