Abstract
BackgroundAlthough the National Comprehensive Cancer Network (NCCN) Guidelines recommend CCRT+AC and IC + CCRT as level 2A evidence for treatment of the locoregionally advanced NPC (II-IVa), IC + CCRT+AC could also be an alternative but it is seldom used because of the low completion rates. This article aimed to compare the effectiveness of the three radiotherapy regimens using a large-scale retrospective study.MethodsThis retrospective single center analysis enrolled 1812 diagnosed NPC patients at Nanfang Hospital from January 2005 to December 2015 and only 729 patients met the inclusion criteria and were analyzed. Patients without distant metastasis, age of 18–70 years, Karnofsky scores of at least 70,stage III-IVb, and adequate adequate bone marrow, liver and renal function. Were enrolled. Adverse events and other categorical variables were compared by Pearson chi-square test or Fishier exact test. Time-to-event data were described with the Kaplan-Meier curves, time-to-event intervals compared with the log-rank test. We did multivariable analyses with the Cox proportional hazards model to test the independent signifi cance of diff erent factors. Cox proportional hazards model was used to estimate the β regression coeffi cient, p value, and hazard ratio and its 95% CI for each of the selected risk predictors.ResultsThe median follow-up time was 47 months. Kaplan-Meier analyses revealed no significant differences among three groups in 3-year failure-free survival (FFS, P = 0.225), 3-year overall survival (OS, P = 0.992), 3-year locoregional failure-free survival (LFFS, P = 0.549), and 3-year distant failure-free survival (DFFS, P = 0.174). Stratified survival analysis based on the risk scoring model revealed no differences in FFS, OS, LFFS, and DFFS between IC + CCRT and CCRT+AC groups for low-risk patients, however, the 3-year OS (88.3% vs. 77.6%, P = 0.049) and 3-year DFFS (84.0% vs.66.8%, P = 0.032) were respectively significantly better in IC + CCRT group compared with CCRT+AC group for high-risk patients.ConclusionsCompared with CCRT+AC, IC + CCRT lowers distant metastasis rate and improves OS among patients with locally advanced NPC in high risk group.
Highlights
The National Comprehensive Cancer Network (NCCN) Guidelines recommend concurrent chemoradiotherapy (CCRT)+adjuvant chemotherapy (AC) and induction chemotherapy (IC) + CCRT as level 2A evidence for treatment of the locoregionally advanced Nasopharyngeal carcinoma (NPC) (II-IVa), IC + CCRT+AC could be an alternative but it is seldom used because of the low completion rates
The platinum-based concurrent chemoradiotherapy (CCRT) regimen is recommended by the NCCN Guidelines for advanced stage NPC patients [2,3,4], but almost 30% of NPC patients are prone to suffer from locoregional recurrence or distant metastases and experience treatment failure [2, 3, 5]
Further analysis demonstrated that the incidence rate of grade 3–4 leukopenia was significantly lower in IC + CCRT group than those of CCRT+AC and IC + CCRT+AC groups (16.4% vs. 31.8 and 28.8% respectively, both P < 0.01), but no significant difference was found between CCRT+AC group and IC + CCRT+AC group (P = 0.49) (Table 2)
Summary
The National Comprehensive Cancer Network (NCCN) Guidelines recommend CCRT+AC and IC + CCRT as level 2A evidence for treatment of the locoregionally advanced NPC (II-IVa), IC + CCRT+AC could be an alternative but it is seldom used because of the low completion rates. 70% of newly diagnosed NPC patients present with stage III or IV disease due to difficulties in early detection and high incidences of locoregional metastasis and distant metastasis [2]. The platinum-based concurrent chemoradiotherapy (CCRT) regimen is recommended by the NCCN Guidelines for advanced stage NPC patients [2,3,4], but almost 30% of NPC patients are prone to suffer from locoregional recurrence or distant metastases and experience treatment failure [2, 3, 5].
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