Abstract
PurposeThe objective of this study is to evaluate the contribution of induction (IC) or adjuvant (AC) chemotherapy additional to concurrent chemoradiotherapy (CCRT) for patients with T3-4N0-1 nasopharyngeal carcinoma (NPC) in the era of intensity-modulate radiotherapy (IMRT).Method and MaterialsWe retrospectively reviewed the data on 685 patients with newly diagnosed T3-4N0-1 NPC. Propensity score matching (PSM) method was used to match patients. Survival outcomes between different groups were calculated by Kaplan-Meier method and compared using log-rank test. Cox proportional hazard model was adopted to establish independent prognostic factors.ResultsIn total, 236 pairs were selected from the primary cohort. Univariate analysis revealed 3-year overall survival (OS) (90.8% vs. 90.3%, P = 0.820), distant failure-free survival (DFFS) (87.3% vs. 89.4%, P = 0.896) and locoregional failure-free survival (LRFFS) (95.4% vs. 93.0%, P = 0.311) rates were comparable between CCRT plus IC/AC and CCRT alone groups. Multivariate analysis found that treatment group was not an independent prognostic factors for OS (HR, 0.964; 95% CI, 0.620-1.499; P = 0.869), DFFS (HR, 1.036; 95% CI, 0.626-1.714; P = 0.890) and LRFFS (HR, 0.670; 95% CI, 0.338-1.327; P = 0.250). Further subgroup analysis according to overall stage also obtained similar results.ConclusionPatients with T3-4N0-1 NPC receiving CCRT could not benefit from additional induction or adjuvant chemotherapy in the era of IMRT.
Highlights
Nasopharyngeal carcinoma (NPC) is a head and neck malignancy that is endemic in South East Asia and Southern China [1,2,3], but relatively rare in Europe and the United States [2]
The objective of this study is to evaluate the contribution of induction (IC) or adjuvant (AC) chemotherapy additional to concurrent chemoradiotherapy (CCRT) for patients with T3-4N0-1 nasopharyngeal carcinoma (NPC) in the era of intensity-modulate radiotherapy (IMRT)
Univariate analysis revealed 3-year overall survival (OS) (90.8% vs. 90.3%, P = 0.820), distant failure-free survival (DFFS) (87.3% vs. 89.4%, P = 0.896) and locoregional failurefree survival (LRFFS) (95.4% vs. 93.0%, P = 0.311) rates were comparable between CCRT plus IC/adjuvant chemotherapy (AC) and CCRT alone groups
Summary
Nasopharyngeal carcinoma (NPC) is a head and neck malignancy that is endemic in South East Asia and Southern China [1,2,3], but relatively rare in Europe and the United States [2]. Treatment outcomes of early stage disease are usually excellent; the control of advanced NPC is challenging, and the condition has a 5-year overall survival (OS) of 67–79% [4, 5]. There is a lack of consensus among clinicians on the necessity of chemotherapy additional to CCRT in patients with N0-1-category locoregionally advanced NPC because this proportion of patients presents a relatively low rate of distant failure. Previous studies usually recruited all patients with stage III and IVA-B disease and did not characterize this issue. This urgently needs to be addressed because additional of chemotherapy means more toxicities and heavier economic burden. We conducted this retrospective study to compare CCRT plus IC and/or AC with CCRT alone using propensity score matching (PSM) method [23]
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