Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

Abstract

Purpose: This study aimed to compare the efficacy of induction-concurrent (IC-CCRT) with concurrent-adjuvant (CCRT-AC) chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated by intensity-modulated radiotherapy (IMRT). Materials and Methods: Data on 834 patients with newly diagnosed, non-metastatic stage III-IVA (except T3N0) NPC receiving either IC-CCRT or CCRT-AC between July, 2004 and December, 2014 were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance prognostic factors and match patients. Survival outcomes of matched patients between IC-CCRT and CCRT-AC were compared. Results: The median follow-up duration is 45.2 months (range, 1.07-145.4 months). Overall, 309 pairs were selected by PSM. Univariate analysis revealed the CCRT-AC group achieved significantly higher 3-year DFS (83.9% vs. 78.7 %; P = 0.014) and OS (87.6% vs. 87.0%; P = 0.031). Multivariate analysis also identified treatment group (IC-CCRT vs. CCRT-AC) as an independent prognostic factor for 3-year DFS (HR, 1.546; 95% CI, 1.113-2.149; P = 0.009) and OS (HR, 1.487; 95% CI, 1.035-2.136; P = 0.032). Subgroup analysis revealed IC-CCRT was a protective factor for DMFS (HR, 0.145; 95% CI, 0.043-0.488; P = 0.002) in stage III disease; however, it could adversely affected DFS (HR, 2.009; 95% CI, 1.316-3.065; P = 0.001), OS (HR, 1.671; 95% CI, 1.060-2.636; P = 0.027) and DMFS (HR, 1.986; 95% CI, 1.155-3.416; P = 0.013) in stage IVA disease. Conclusions: CCRT-AC may be a more effective treatment modality in patients with stage IVA NPC disease, while IC-CCRT was superior in stage III disease.

Concurrent chemoradiotherapy with additional chemotherapy for nasopharyngeal carcinoma: A pooled analysis of propensity score‐matching studies

“…The characteristics of the patients included in the 14 eligible studies 17‐30 are shown in Table 1. A total of 4086 participants were involved in this meta‐analysis, of whom 2014 received CCRT with additional chemotherapy and 2072 received CCRT alone.…”

“…Ten studies 17‐20,23‐25,27,28,30 investigated IC + CCRT, which included 1431 participants. Moreover, four trials 21,22,26,29 explored CCRT + AC in 583 patients. Eleven studies 18‐20,22‐29 involved 1:1 PSM analysis, Two studies 21,30 involved 1:2 PSM analysis, and 2:1 PSM analysis was conducted in only one study 17 .…”

<p>The Double-Edge Role of the Addition of Adjuvant Chemotherapy to Concurrent Chemoradiotherapy in the Treatment of Nasopharyngeal Carcinoma</p>

“…Similar results regarding the negative role of adjuvant chemotherapy were observed by Skillington et al, who reported that the addition of adjuvant chemotherapy to a radiotherapy regimen was associated with worse overall survival in patients with p16-positive oropharyngeal squamous cell carcinoma (adjusted HR, 1.46; 95% CI, 0.91-2.33). 23 During adjuvant chemotherapy, a cohort of patients with NPC experienced grade 3-4 dysphagia, nausea, and vomiting, 24,25 leading to weight loss and nutritional deficiency. Indeed, poor nutritional status has a negative influence on overall survival and distant metastasis-free survival in NPC patients, [26][27][28] which may correlate with the negative impacts of adjuvant chemotherapy observed in the present study.…”

Revalidation of a prognostic score model based on complete blood count for nasopharyngeal carcinoma through a prospective study

“…A more intensive systemic therapy such as ACT might be needed. But a certain conclusion of the impact of ACT on locoregionally advanced NPC is still unable to make, through the results of the studies so far (36-38). And ACT plus CCRT was proved to cause more acute adverse reactions such as severe bone marrow suppression and gastrointestinal reactions, compared with CCRT alone (38).…”