Induction Chemotherapy Has No Prognostic Value in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma and Chronic Hepatitis B Infection in the IMRT Era

Abstract

BACKGROUND: The effectiveness of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) over CCRT alone in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and chronic hepatitis B infection in the intensity-modulated radiotherapy (IMRT) era is unknown. PATIENTS AND METHODS: A total of 249 patients with stage T1-2 N2-3 or T3-4 N1-3 NPC and chronic hepatitis B infection treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) was employed to balance covariates; 140 patients were propensity-matched (1:1 basis). Survival outcomes in the IC + CCRT and CCRT groups were compared using the Kaplan–Meier method, log-rank test and Cox proportional hazards model. RESULTS: No significant survival differences were observed between IC + CCRT and CCRT (5-year overall survival, 88.3% vs. 82.2%; P = .484; disease-free survival, 73.9% vs. 75.2%; P = .643; distant metastasis-free survival, 84.1% vs. 85.1%; P = .781; and locoregional failure-free survival, 87.9% vs. 85.1%; P = .834). After adjusting for known prognostic factors in multivariate analysis, IC was not an independent prognostic factor for any outcome (all P > .05); subgroup analysis based on T category (T1-2/T3-4), N category (N0-1/N2-3), and overall stage (III/IV) confirmed these results. The incidence of hepatic function damage in the IC + CCRT and CCRT groups was not significantly different. CONCLUSION: IC + CCRT leads to comparable survival outcomes and hepatic function damage compared to CCRT alone in patients with locoregionally advanced NPC with chronic hepatitis B infection in the IMRT era. Further investigations are warranted.

The efficacy and safety of concurrent chemoradiotherapy with induction chemotherapy vs. concurrent chemoradiotherapy alone for locally advanced nasopharyngeal carcinoma: a systematic-review and meta-analysis

“…This study initially retrieved 797 articles, and 13 studies were finally included ( 6 - 7 , 10 - 20 ). The selection flow chart is shown in Figure 1 .…”

“…A previous case-control study by Li et al ( 6 ) has reported that the addition of IC prior to CCRT can reduce the rate of distant metastasis and improve the survival rate of patients with nasopharyngeal carcinoma. However, another study by Zhang et al ( 7 ) has suggested that for specific patients (NPC with chronic hepatitis B infection), IC does not provide a significant efficacy gain for CCRT, but increases the toxicity and liver burden. A meta-analysis is the best way to resolve the controversies ( 8 ).…”

A Pairwise Meta-Analysis of Induction Chemotherapy in Nasopharyngeal Carcinoma

“…In the real‐world clinical practice, however, the efficacy of induction chemotherapy was minimal, as observed in different populations . Perhaps a more precise selection of real high‐risk patients based on prognostic tools (e.g., tumor volume , Epstein‐Barr virus deoxyribonucleic acid , or nomogram ) and application of new chemotherapy regimens might be the promising strategies for induction chemotherapy in the future.…”

<p>Long-Term Survival After Nasopharyngeal Carcinoma Treatment in a Local Prefecture-Level Hospital in Southern China</p>

“…An explanation to that is that in this study, 112 (94.1%) patients with stage III and IV received ICT, and in the IMRT era, ICT applied in loco-regionally advanced nasopharyngeal carcinoma can significantly reduce the risk of distant metastasis. 20,[27][28][29] In addition, N stage was an independent predictor for DMFS in the multivariate Cox proportional hazards model analysis due to lymphatic drainage into the blood. That finding was consistent with the latest research.…”