Explore the Usefulness of Concurrent Chemotherapy in Stage II Nasopharyngeal Carcinoma: A Retrospective Study

Abstract

Objective: This study aims to compare the treatment outcomes of concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in stage II nasopharyngeal carcinoma (NPC) patients.Methods: We retrospectively collected 601 stage II NPC patients treated in two hospitals between June 2003 to June 2016. All patients were divided into the CCRT group (n = 255) and the RT group (n = 346). Overall survival (OS), locoregional failure-free survival (LRFFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. The log-rank test was used to compare the differences between the groups. The Cox-regression hazards model was performed to determine potential prognostic factors.Results: The median follow-up was 99 months. No significant difference was found in locoregional recurrence, distant metastasis, disease progression, and death between the two groups (all p > 0.05). In univariate analysis, the 5-years OS, PFS, LRFFS, and DMFS had no significant differences between the CCRT and RT groups (all p > 0.05). Two-dimensional radiotherapy (2DRT) sub-analysis showed that CCRT remarkably increased DMFS, PFS, and OS rates (all p < 0.05) but not LRFFS (p = 0.258) compared with RT alone. While intensity-modulated radiotherapy (IMRT) sub-analysis showed that the prognosis of the two groups had no significant differences (all p > 0.05). In multivariate analyses, age was significantly and inversely related to OS, PFS, LRFFS, and DMFS. IMRT was an independent favorable factor for improving LRFFS, PFS, and OS. Concurrent chemotherapy was an independent protective factor for DMFS.Conclusion: In the context of 2DRT, it is definite that concurrent chemotherapy provides survival benefits for patients with stage II NPC. While in the IMRT era, the impact of chemotherapy on survival in patients with stage II NPC is weakened. Prospective randomized controlled studies are required to confirm these results.

A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma

“…The stability of the results was evaluated by removing some studies according to different standards ( Table 3 ). First of all, the sensitivity analysis was conducted in IMRT studies by separately eliminating two studies ( 8 , 35 ) with a sample size of less than 100 patients, four studies ( 11 , 32 , 33 , 35 ) with a median follow-up time of fewer than 60 months, and three studies ( 11 , 33 , 34 ) that included concurrent chemotherapy regimens other than cisplatin, respectively. It suggested that OS, LRFS, DMFS, and PFS were similar between the CCRT group and IMRT alone group, which was consistent with that before sensitivity analysis.…”

“…IMRT has become a daily choice for NPC. Several studies (8,11,(32)(33)(34)(35)(36) have investigated whether concurrent chemotherapy can further improve the efficacy of stage II NPC patients receiving IMRT. However, the results of these studies are not completely consistent.…”

“…Among the remaining 22 studies, six studies (19)(20)(21)(22)(23)(24) involving patients with adjuvant or neoadjuvant chemotherapy were excluded, another six studies (25)(26)(27)(28)(29)(30) involving patients with stage I or III were eliminated, and one study (31) with insufficient data was also eliminated (Figure 1). Nine studies were finally included, two of which were RCTs (8,9), and the rest were retrospective studies (10,11,(32)(33)(34)(35)(36). A total of 4,092 patients were enrolled, 2,462 received CCRT, and 1,632 received RT alone.…”

“…A total of 4,092 patients were enrolled, 2,462 received CCRT, and 1,632 received RT alone. There are four studies (9,10,32,34) with a total of 2,490 patients that investigated 2DRT combined with concurrent chemotherapy, and 7 studies (8,11,(32)(33)(34)(35)(36) with 1,602 patients that explored IMRT plus concurrent chemotherapy (Table 1). According to RoB2 assessment criteria, the overall risk of bias was low for the two included RCTs (Figure 2).…”

Individualized Concurrent Chemotherapy for Patients with Stage III-IVa Nasopharyngeal Carcinoma Receiving Neoadjuvant Chemotherapy Combined with Definitive Intensity-Modulated Radiotherapy

“…The locoregional control rate of NPC has markedly improved since the widespread use of IMRT [5], challenging the role of CCT as part of the treatment. Several studies revealed that the combination of NCT plus IMRT was as effective as NCT plus CCRT for managing locally advanced NPC [17][18][19]. However, most studies are limited by inconsistent chemotherapy regimens and NCT cycles, making it difficult to draw convincing conclusions.…”