Adjuvant chemotherapy following combined induction chemotherapy and concurrent chemoradiotherapy improves survival in N2–3-positive nasopharyngeal carcinoma patients

Abstract

Objective: This study aimed to explore the clinical value of adjuvant chemotherapy (ACT) in locoregionally advanced nasopharyngeal carcinoma (LANC) following concurrent chemoradiotherapy (CCRT) and induction chemotherapy (ICT).Methods: We included 839 newly diagnosed LANC patients in the study. ICT plus CCRT (ICT+CCRT group) was administered to 443 patients and 396 patients who received ACT after receiving ICT plus CCRT (ICT+CCRT+ACT group). Univariate and multivariate Cox regression analyses were carried out in this study. Furthermore, to balance the study and control groups, propensity score matching (PSM) was applied.Results: 373 pairs of LANC patients were obtained after the PSM analysis. We found that ACT following ICT+CCRT had no signi cant effect on improving the survival of LANC patients. By further exploring the ICT+CCRT+ACT regimen, we excluded N0-1-positive patients and performed PSM in the ICT+CCRT and ICT+CCRT+ACT groups again. Each group consisted of 237 patients. Kaplan-Meier analysis revealed that there was a difference between the ICT+CCRT and ICT+CCRT+ACT groups in terms of the 5-year overall survival (OS) (78.9% vs. 85.0%, P = 0.034), disease-free survival (DFS) (73.4% vs. 81.7%, P = 0.029), and distant metastasis-free survival (DMFS) (84.9% vs. 76.0%, P = 0.019). In addition, the ICT+CCRT+ACT group had a higher incidence of grade 3-4 acute leukocytopenia/neutropenia. Conclusion: Compared with ICT+CCRT, ACT following ICT plus CCRT can reduce distant metastasis of N2-3-positive LANC and improve the OS and DFS of these patients, thus demonstrating higher clinical feasibility.

Efficacy of adjuvant chemotherapy/maintenance chemotherapy after induction chemotherapy and concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Experiences of two centers

“…However, we used PSM to balance the two cohorts of patients who underwent the IC+CCRT or IC+CCRT+AC/MC therapeutic protocol, and the results showed that two cohorts have similar survival outcomes. This result is consistent with Zou et al's and Tao et al's study 10,38 . Chen et al performed a study to explore the correlation between postradiotherapy (RT) EB‐DNA levels and AC with cisplatin plus gemcitabine, and they found that AC did not benefit patients who had high levels of EB‐DNA after RT 39 .…”

“…Additionally, Zhang et al and Tao et al showed that AC using TP was an effective treatment option for LA‐NPC patients, and most patients tolerated it. 10 , 35 Cisplatin plus 5‐fluorouracil (PF) is the only AC treatment option recommended by the NCCN guidelines to date. 4 5‐Fluorouracil can effectively damage tumor cells since it can inhibit thymidine synthase and affect DNA synthesis and is widely used in a variety of solid tumors.…”

“…This result is consistent with Zou et al's and Tao et al's study. 10 , 38 Chen et al performed a study to explore the correlation between postradiotherapy (RT) EB‐DNA levels and AC with cisplatin plus gemcitabine, and they found that AC did not benefit patients who had high levels of EB‐DNA after RT. 39 These research conclusions indicate that we may need to further investigate the clinical value of AC from other perspectives.…”

“… 9 Tao et al's results showed that patients with N2‐3 positivity could benefit from adjuvant chemotherapy (AC) following IC+CCRT. 10 Additionally, studies have demonstrated that cervical lymph node (CLN) necrosis and infiltration of adjacent structures can adversely affect patient prognosis. 11 , 12 , 13 In this article, we screened the essential prognostic factors based on imaging data and clinical characteristics to further explore the value of AC or MC following IC+CCRT in patients with LA‐NPC.…”

“…According to Chen et al, maintenance chemotherapy (MC) with capecitabine can further increase the survival rate of LA‐NPC patients 9 . Tao et al's results showed that patients with N2‐3 positivity could benefit from adjuvant chemotherapy (AC) following IC+CCRT 10 . Additionally, studies have demonstrated that cervical lymph node (CLN) necrosis and infiltration of adjacent structures can adversely affect patient prognosis 11–13 .…”