The Clinical Outcomes and Toxicities of Induction Chemotherapy Followed by Concurrent Chemoradiotherapy Plus Adjuvant Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma.

Rui Zou,Jing-Jing Yuan,Bing Liao,Jian-Wu Ding,Zi-Wei Tu,Rong-Huan Hu,Qiang Li,Jia-Li Hu,Dan Gong,Lei Zeng

doi:10.3389/fonc.2020.619625

Abstract

PurposeTo analyze the outcomes and toxicities of induction chemotherapy (ICT) followed by concurrent chemoradiotherapy (CCRT) plus adjuvant chemotherapy (ACT) in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).MethodsRetrospective analysis of 163 patients with LA-NPC referred from August 2015 to December 2018 was carried out. All patients underwent platinum-based ICT followed by CCRT plus ACT.ResultsThe median follow-up time was 40 months, ranging from 5 to 69 months. The 3-year disease-free survival (DFS), overall survival (OS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates were 80.8, 90.0, 91.6, and 87.4%, respectively. The most frequent acute grade 3/4 adverse events were leukopenia (66.8%), neutropenia (55.8%), mucositis (41.1%), thrombocytopenia (27.0%), and anemia (14.7%).ConclusionICT followed by CCRT plus ACT did not seemingly enhance DFS and OS in LA-NPC patients compared to the addition of ICT to CCRT (historical controls). In contrast, ICT followed by CCRT plus ACT had more acute adverse events than ICT followed by CCRT. Longer-term clinical studies are required to examine the treatment outcomes and late toxicities.

Highlights

The location of nasopharyngeal cavity is deep and hidden, and the lesions are notoriously difficult to detect at an early stage
induction chemotherapy (ICT) followed by concurrent chemoradiotherapy (CCRT) can serve as a potential treatment strategy for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) patients receiving intensity-modulated radiation therapy (IMRT)
In the multivariate analysis of all 163 patients, T category was identified as an independent prognostic factor for disease-free survival (DFS) and distant metastasis-free survival (DMFS); while N category was independently associated with DFS, DMFS, and overall survival (OS)

Summary

Introduction

The location of nasopharyngeal cavity is deep and hidden, and the lesions are notoriously difficult to detect at an early stage. The landmark Intergroup-0099 randomized trial was the first to demonstrate that concurrent treatment of CCRT and ACT could increase the 3-year overall survival (OS) rate by 31% compared to radiotherapy alone group [3]. Thenceforth, this regimen is deemed as a standard-of-care for patients with LA-NPC. A meta-analysis conducted by MAC-NPC collaborative group has shown that the use of chemotherapy could be beneficial for improving the survival endpoints (e.g., cancer mortality, distant control, locoregional control, and progression-free survival), and based on the timing of chemotherapy, CCRT plus ACT was most favorable compared to CCRT alone, ICT alone, and ACT alone [5]. CCRT plus ACT is still considered as 2A recommendation in the National Comprehensive Cancer Network (NCCN) 2020 guidelines for treating head and neck tumors

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