Induction versus adjuvant chemotherapy combined with concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a retrospective cohort study

Abstract

Background: Currently available evidence favors the combination of chemotherapy with concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma (LANPC). However, the optimal timing for additional chemotherapy is unclear. This study was conducted to compare the efficacy and toxicity of induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) versus concurrent chemoradiotherapy plus adjuvant chemotherapy (CCRT+AC). Methods: Two medical centers in China enrolled patients with LANPC (stage III-IVB) between January 2009 and May 2020. Through the use of propensity score matching (PSM), baseline characteristics were balanced. The primary endpoint was overall survival (OS), which was evaluated by the Kaplan-Meier method and log-rank test. Potential independent prognostic factors were identified using univariate and multivariate Cox proportional hazard analyses. Based on the chi-squared test, we compared the adverse events associated with treatment between the groups. Results: After the implementation of PSM, 159 patients treated with IC+CCRT and 72 patients treated with CCRT+AC were eventually enrolled in this study. There was no significant difference between patients treated with IC+CCRT and CCRT+AC in terms of 3-year OS (94.7% versus 90.9%, p=0.816), progression-free survival (PFS) (91.2% versus 83.1%, p=0.588), locoregional recurrence-free survival (LRFS) (92.5% versus 81.8%, p=0.478), or distant metastasis-free survival (DMFS) (93.4% versus 88.2%, p=0.783). There was no prognostic significance of the treatment for OS, PFS, LRFS, or DMFS (all p > 0.05) in the univariate and multivariate analyses. Patients treated with CCRT+AC had a higher incidence of grade 3 to 4 leucopenia (p=0.001) and neutropenia (p=0.001) than those treated with IC+CCRT. Conclusions: IC plus CCRT achieved comparable survival outcomes to CCRT plus AC and had a lower incidence of toxicity.

TPF induction chemotherapy versus PF adjuvant chemotherapy plus concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: a multicenter, randomized controlled phase III trial

“…Both groups had similar compliance rates for radiotherapy and chemotherapy, but the IC group experienced fewer toxic effects during CCRT such as nausea, dermatitis, mucositis, swallowing, and dryness. These ndings provide further evidence in support of previous studies indicating that the survival outcomes after IC + CCRT are consistent with those after CCRT + AC 23,24,30 , while toxic side effects were increased during CCRT 19,20,[31][32][33] .…”

Comparative Study between Patients Treated with Conventional Radiotherapy and IMRT with Chemotherapy for Stage III - IVA Nasopharyngeal Carcinoma: A Single Institution Retrospective Report

“…The ability to sculpt the dose to the target volume has resulted in significant toxicity, and the risk of permanent feeding tube dependence with conventional RT is high during and after irradiation. Compared with the more morbid severe oropharyngeal mucositis, xerostomia, soft tissue fibrosis, dysphagia with conventional RT, IMRT has been routine choice in the past three decade [14]. In This article, we reported the outcome of 218 NPC who underwent definitive RT with conventional RT + CT and IMRT + CT. We found that not only was the treatment outcome improved, but at the same time treatment-related toxicity was significantly reduced by IMRT.…”