Outcomes of adding induction chemotherapy to concurrent chemoradiotherapy for stage T3N0-1 nasopharyngeal carcinoma: a propensity-matched study

Abstract

ObjectiveOur objective was to examine whether adding induction chemotherapy to concurrent chemoradiotherapy improved survival in stage III nasopharyngeal carcinoma (NPC) patients, especially in low-risk patients at stage T3N0-1.Materials and methodsWe retrospectively analyzed 687 patients with stage T3N0-1 NPC treated with intensity-modulated radiation therapy (IMRT) plus concurrent chemotherapy (CC) with or without induction chemotherapy (IC). Propensity score matching (PSM) method was used to select 237 pairs of patients from two cohorts. Overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) were assessed by using the Kaplan–Meier method, log-rank test, and Cox regression analysis.ResultsNo significant survival differences were observed between IC plus CC and CC cohorts with similar 4-year OS (91.7% vs 92.6%, P=0.794), LRFS, (92.7% vs 96.8%, P=0.138), DMFS (93.5% vs 94.3%, P=0.582), and PFS (87.5% vs 91.1%, P=0.223). In a univariate analysis, lower Epstein–Barr virus deoxyribonucleic acid (EBV DNA; <4,000 copies/mL) significantly improved 4-year DMFS (95.5% vs 91.6%, P=0.044) compared with higher EBV DNA (≥4,000 copies/mL). No factors were associated with 4-year OS, LRFS, DMFS, and PFS in a multivariate analysis. IC plus CC group experienced higher rates of grade 3–4 leucopenia (P<0.001) and neutropenia (P<0.001).ConclusionThe addition of IC to CC in stage T3N0-1 NPC patients treated with IMRT did not significantly improve their survival. The IC group experienced higher rates of grade 3–4 hematological toxicities. Therefore, further investigation is required.

Efficacy and safety of intensity-modulated radiotherapy alone versus intensity-modulated radiotherapy plus chemotherapy for treatment of intermediate-risk nasopharyngeal carcinoma

“…In the present study, the overall incidence of grade 3 acute toxic effects was higher in the IMRT/chemotherapy group than in the IMRT-only group; significantly higher incidence was seen of grade 3 leukopenia/neutropenia, nausea/vomiting, and mucositis. Some earlier studies have reported similar findings [7,13]. We separated the patients into different subgroups according to various baseline factors.…”

“…Second, the high frequency of severe adverse reactions in patients treated with IMRT/chemotherapy may have masked any survival benefit in this group [17]. Lan et al have also found that addition of chemotherapy to IMRT does not significantly improve OS; additionally, the authors reported that the higher the incidence of grade 3-4 acute toxicities (especially hematological events such as leucopenia and neutropenia [13]) increases the possibility of discontinuation of treatment. Thus, it seems that IMRT alone may be more suitable than CCRT for patients with stage II and T3N0M0 NPC.…”

Stratification of Candidates for Induction Chemotherapy in Stage III-IV Nasopharyngeal Carcinoma: A Large Cohort Study Based on a Comprehensive Prognostic Model

“…Recently, several clinical trials have provided evidence that IC before definitive CCRT is associated with lower incidence of distant metastases and further improved patient survival (7,18,19). However, according to studies among patients with stage T3-4 N0-1, clinical outcome was similar between the CCRT and IC + CCRT groups, indicating that IC might benefit only patients with a greater tumor burden (9,10). Considering the toxicity and economic cost of chemotherapy, it is important to identify suitable patients who could benefit from additional IC.…”

“…Nevertheless, not all patients with locoregionally advanced NPC benefit from IC. Previous studies have reported that IC might not improve survival among patients with T3-4N0-1 NPC; in fact, IC has been associated with severe toxicity in this patient group (9,10). Given the body of evidence, it is likely that patients at high risk might benefit from IC more than patients at low risk.…”

Prognostic Value of Deep Learning PET/CT-Based Radiomics: Potential Role for Future Individual Induction Chemotherapy in Advanced Nasopharyngeal Carcinoma

“…Consequently, IC has been routinely recommended for advanced NPC. However, it should be pointed out that the advanced disease consisted of many subgroups and not all of them could benefit from additional IC (10,11). Thus, identifying the high-risk subgroups who could benefit from IC is the key to improve management of advanced NPC.…”