Comparison of radiotherapy combined with nimotuzumab vs. chemoradiotherapy for locally recurrent nasopharyngeal carcinoma

Abstract

Background The present study compared the effectiveness and toxicity of two treatment modalities, namely radiotherapy combined with nimotuzumab (N) and chemoradiotherapy (CRT) in patients with locally recurrent nasopharyngeal carcinoma (LR-NPC). Methods Patients with LR-NPC who were treated with radiotherapy were retrospectively enrolled from January 2015 to December 2018. The treatment included radiotherapy combined with N or platinum-based induction chemotherapy and/or concurrent chemotherapy. The comparison of survival and toxicity between the two treatment modalities was evaluated using the log-rank and chi-squared tests. Overall survival (OS) was the primary endpoint. Results A total of 87 patients were included, of whom 32 and 55 were divided into the N group and the CRT group, respectively. No significant differences were noted in the survival rate between the N and the CRT groups (4-year OS rates, 37.1% vs. 40.7%, respectively; P = 0.735). Mild to moderate acute complications were common during the radiation period and mainly included mucositis and xerostomia. The majority of the acute toxic reactions were tolerated well. A total of 48 patients (55.2%) demonstrated late radiation injuries of grade ≥ 3, including 12 patients (37.5%) in the N group and 36 patients (66.5%) in the CRT group. The CRT group exhibited significantly higher incidence of severe late radiation injuries compared with that of the N group (P = 0.011). Conclusion Radiotherapy combined with N did not appear to enhance treatment efficacy compared with CRT in patients with LR-NPC. However, radiotherapy combined with N may be superior to CRT due to its lower incidence of acute and late toxicities. Further studies are required to confirm the current findings.

Treatment of Recurrent Nasopharyngeal Carcinoma: A Sequential Challenge

“…Compared with chemotherapeutic agents, the use of targeted therapy and immunotherapy in recurrent NPC is relatively limited, and in most cases they are not used alone, but in combination with chemotherapeutic agents or radiotherapy to provide better benefits [ 115 , 116 , 117 , 118 , 119 ]. A clinical study published by Ng et al showed that weekly IMRT with docetaxel plus cetuximab was shown to be effective in advanced recurrent NPC compared to TPF-induced chemotherapy, with a 3-year progression-free survival rate of 35.7% [ 107 ].…”

Impact of Radiotherapy Combined With Chemotherapy on Long-Term Outcomes of Patients With Recurrent Nasopharyngeal Carcinoma

“… 30 Previous studies reported that nearly 55% of rNPC patients exhibited late radiation injuries more severe than grade 3 injuries, whereas 30% exhibited grade 5 injuries including nasopharyngeal necrosis, necrosis of the internal carotid artery, or other vessels, temporal lobe necrosis, and so on. 15 , 31 Some of these severe toxicities may be related to the large fraction size used in previously heavily irradiated normal tissues. In the current study, all patients were initially treated with RT including conventional RT and IMRT.…”

“… 9 , 29 , 32 Zong et al reported that the rT category and chemotherapy are associated with the incidence of severe late radiation injury. 31 It was demonstrated that rNPC patients receiving RCT suffered more late toxicity than those treated with RT alone. 33 Previous studies have indicated that chemotherapy was the major contributor to severe grade 3 acute hematological toxicities.…”

“… 33 Previous studies have indicated that chemotherapy was the major contributor to severe grade 3 acute hematological toxicities. 31 In addition, some studies demonstrated that the use of chemotherapy at any phase can lead to significant toxicities. 31 Our results show that radiation damage and acute hematological toxicities were more likely to be found in the RCT group.…”

“… 31 In addition, some studies demonstrated that the use of chemotherapy at any phase can lead to significant toxicities. 31 Our results show that radiation damage and acute hematological toxicities were more likely to be found in the RCT group. Although the late radiation injuries noted in the RCT group were not significantly different as compared with the RT group, 34 thus, the addition of chemotherapy to re-RT in rNPC patients needs careful consideration given the apparent increase in toxicities.…”