Abstract
ObjectivesInduction chemotherapy (IC) now is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). The current study was conducted to examine the association between prognosis and the interval between IC and radiotherapy (RT) in NPC patients.MethodsPatients with newly diagnosed, non-metastatic NPC who were treated with IC followed by RT from 2009 to 2012 were identified from an inpatient database. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS) were compared between those with interval ≤ 30 and > 30 days by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis.ResultsA total of 668 patients met inclusion criteria with median follow-up of 64.4 months. Patients were categorized by interval: 608 patients with interval ≤ 30 days, and 60 with interval > 30 days. The 5-year OS, DFS, DMFS and LRFS rates were 86.6, 78.2, 88.0 and 89.8% for patients with interval ≤ 30 days, respectively, and 69.2, 64.5, 71.2 and 85.1% for patients with interval > 30 days, respectively. The prolonged interval was a risk factor for OS, DFS and DMFS with adjusted hazard ratios (95% confidence intervals) were 2.44 (1.48–4.01), 1.99 (1.27–3.11) and 2.62 (1.54–4.47), respectively.ConclusionsProlonged interval > 30 days was associated with a significantly higher risk of distant metastasis and death in NPC patients. Efforts should be made to avoid prolonged interval between IC and RT to minimize the risk of treatment failure.
Highlights
Nasopharyngeal carcinoma (NPC) is endemic in southern China, where the age-standardized annual incidence was 5–11 cases per 100,000 in endemic provinces, increasing to 10–27 cases in endemic counties [1]
We hypothesized that the longer interval between induction chemotherapy (IC) and RT would be associated with worse survival in NPC patients
The interval > 30 days remained a significant negative prognostic factor for NPC patients in terms of Overall survival (OS) (HR 2.44, 95% Confidence interval (CI) 1.48–4.01), disease-free survival (DFS) (HR 1.99, 95% CI 1.27–3.11) and distant metastasis-free survival (DMFS) (HR 2.62, 95% CI 1.54–4.47)
Summary
Nasopharyngeal carcinoma (NPC) is endemic in southern China, where the age-standardized annual incidence was 5–11 cases per 100,000 in endemic provinces, increasing to 10–27 cases in endemic counties [1]. An individual patient data pooled analysis [6] demonstrated that induction chemotherapy (IC), known as neoadjuvant chemotherapy, may (2019) 14:9 effectively decrease the distant metastasis rate and improve survival. To the best of our knowledge, there have been no studies regarding the prognostic value of the interval between IC and RT in NPC. We conducted this retrospective study to investigate the prognostic effect of the interval between IC and RT in NPC patients who received IC prior to RT. We hypothesized that the longer interval between IC and RT would be associated with worse survival in NPC patients
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