OP0005 Neoadjuvant chemotherapy plus chemoradiation (NACT-CCRT) versus chemoradiation plus adjuvant chemotherapy (CCRT-ACT) for locally advanced nasopharyngeal cancer: 3-Year results from a randomised trial

Abstract

Background We did a randomised study to compare the efficacy of neoadjuvant chemotherapy plus chemoradiation (NACT-CCRT) versus chemoradiation plus adjuvant chemotherapy (CCRT-ACT) for locally advanced nasopharyngeal carcinoma. Methods Between 2009 and 2013, 94 patients with histologically proven nasopharyngeal carcinoma (WHO classification II and III) were randomised into two treatment groups. 49 patients were randomly assigned to the NACT-CCRT group and received three cycles of neoadjuvant chemotherapy (every 3 weeks), consisting of docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and fluorouracil 750 mg/m2 on days 1–4 then concurrent chemoradiation with weekly carboplatin AUC 1.5 for six cycles. 45 patients were randomly assigned to the CCRT-ACT group and received concurrent chemoradiation using cisplatin 100 mg/m2 every 3 weeks followed by three cycles of adjuvant chemotherapy consisting of cisplatin 80 mg/m2 on day 1 and fluorouracil 1000 mg/m2 on days 1–4. All patients were treated with intensity-modulated radiation therapy (IMRT) technique with total radiation dose of 70 Gy in 33 fractions to gross disease. Findings The baseline patient characteristics were similar in both groups. The complete treatment rate in the NACT-CCRT and CCRT-ACT groups was 63.3% and 46.7%, respectively. The overall response rate after treatment in the NACT-CCRT and CCRT-ACT groups was 93.9% and 82.3%, respectively. The clinical complete response rate was higher in NACT-CCRT group than in the CCRT-ACT group, although not significantly so (87.8% versus 75.6%, p = 0.42). At a median follow-up of 25 months, the local control rate was 89.7% in NACT-CCRT and 95% in CCRT-ACT arm. The distant metastasis free rate was 91.8% in the NACT-CCRT group and 91.1% in the CCRT-ACT group. 3-year progression-free survival was 72.1% in the NACT-CCRT group and 74.7% in the CCRT-ACT group (p = 0.622). Only manageable toxicities were observed in this study. Interpretation Response rates and progression-free survival were similar in the two groups, with acceptable toxicity. We did a randomised study to compare the efficacy of neoadjuvant chemotherapy plus chemoradiation (NACT-CCRT) versus chemoradiation plus adjuvant chemotherapy (CCRT-ACT) for locally advanced nasopharyngeal carcinoma. Between 2009 and 2013, 94 patients with histologically proven nasopharyngeal carcinoma (WHO classification II and III) were randomised into two treatment groups. 49 patients were randomly assigned to the NACT-CCRT group and received three cycles of neoadjuvant chemotherapy (every 3 weeks), consisting of docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and fluorouracil 750 mg/m2 on days 1–4 then concurrent chemoradiation with weekly carboplatin AUC 1.5 for six cycles. 45 patients were randomly assigned to the CCRT-ACT group and received concurrent chemoradiation using cisplatin 100 mg/m2 every 3 weeks followed by three cycles of adjuvant chemotherapy consisting of cisplatin 80 mg/m2 on day 1 and fluorouracil 1000 mg/m2 on days 1–4. All patients were treated with intensity-modulated radiation therapy (IMRT) technique with total radiation dose of 70 Gy in 33 fractions to gross disease. The baseline patient characteristics were similar in both groups. The complete treatment rate in the NACT-CCRT and CCRT-ACT groups was 63.3% and 46.7%, respectively. The overall response rate after treatment in the NACT-CCRT and CCRT-ACT groups was 93.9% and 82.3%, respectively. The clinical complete response rate was higher in NACT-CCRT group than in the CCRT-ACT group, although not significantly so (87.8% versus 75.6%, p = 0.42). At a median follow-up of 25 months, the local control rate was 89.7% in NACT-CCRT and 95% in CCRT-ACT arm. The distant metastasis free rate was 91.8% in the NACT-CCRT group and 91.1% in the CCRT-ACT group. 3-year progression-free survival was 72.1% in the NACT-CCRT group and 74.7% in the CCRT-ACT group (p = 0.622). Only manageable toxicities were observed in this study. Response rates and progression-free survival were similar in the two groups, with acceptable toxicity.