Necessity of concurrent chemotherapy in N2‐3 nasopharyngeal carcinoma treated with neoadjuvant chemotherapy of ≥3 cycles followed by intensity‐modulated radiotherapy

Abstract

Concurrent chemotherapy (CCT) is used in locally advanced nasopharyngeal carcinoma (NPC) for improved local control, which could also be achieved by intensity‐modulated radiotherapy (IMRT). And for N2‐3 NPC, distant metastasis is the more important cause of death. This study aims to evaluate the value of CCT in N2‐3 NPC when neoadjuvant chemotherapy (NACT) of sufficient cycles is performed to eradicate distant metastasis. It enrolled 959 patients diagnosed with TxN2‐3M0 NPC from July 2011 to December 2015 and treated with NACT of 3‐4 cycles and IMRT. A propensity score matching (PSM) was made between patients treated with and without CCT (called the CCT and non‐CCT groups, respectively), using a series of clinical characteristics (age, gender, T stage, N stage, NACT regimen, and EBV DNA) as covariates. After PSM, the two groups of patients were compared on survivals and acute toxicities. The results indicated that no difference was seen in the overall, disease‐free, recurrence‐free or metastasis‐free survivals between the two groups. But compared with the CCT group, the non‐CCT group had a lower patient proportion of myelosuppression, nausea/vomiting, oral mucositis, cervical dermatitis, xerostomia, and grade 3/4 myelosuppression and oral mucositis (all P values were <0.001). Hence, CCT appeared to bring more acute toxicities, instead of survival benefit, to N2‐3 NPC patients treated with NACT of ≥3 cycles and IMRT. It should be used with cautions in these patients.

WITHDRAWN: Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for nasopharyngeal carcinoma: a prospective cohort study

“…Levy et al [24] also reported that the highest morbidity of acute toxicity was dermatitis (97%) with concurrent radiotherapy and cetuximab after taxane-based induction chemotherapy in locally advanced head and neck cancer. Concurrent chemotherapy in NPC treated with neoadjuvant chemotherapy followed by IMRT was exhibited 48.3% dermatitis, 49.2% oral mucositis, 38.1% bone marrow toxicity, 40.9% xerostomia and 21.2% nausea vomiting [25]. There are more than 40% of patients occurred severity acute injuries for most of locoregional advanced cancer during treatment in previous studies.…”

WITHDRAWN: Radiation-Induced Acute Injury of Intensity-Modulated Radiotherapy vs. Three-Dimensional Conformal Radiotherapy in Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Prospective Cohort Study

“…24 Concurrent chemotherapy in NPC treated with neoadjuvant chemotherapy followed by IMRT was exhibited 48.3% dermatitis, 49.2% oral mucositis, 38.1% bone marrow toxicity, 40.9% xerostomia and 21.2% nausea vomiting. 25 There are more than 40% of patients occurred severity acute injuries for most of locoregional advanced cancer during treatment in previous studies. The investigation of IMRT dose distribution to the skin in head and neck squamous cell carcinoma was reported the incidence of grade 3 and 4 radiation dermatitis was 41.1% in patients included and 50% vs 36.6%…”

Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a prospective cohort study

“…Levy et al also reported that the highest morbidity of acute toxicity was dermatitis (97%) with concurrent radiotherapy and cetuximab after taxane-based induction chemotherapy in locally advanced head and neck cancer 25 . Concurrent chemotherapy in NPC treated with neoadjuvant chemotherapy followed by IMRT was exhibited 48.3% dermatitis, 49.2% oral mucositis, 38.1% bone marrow toxicity, 40.9% xerostomia and 21.2% nausea vomiting 26 . There are more than 40% of patients occurred severity acute injuries for most of locoregional advanced cancer during treatment in previous studies.…”