Outcomes of Induction Chemotherapy Plus Intensity-Modulated Radiotherapy (IMRT) Versus IMRT Plus Concurrent Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Propensity Matched Study

Jiang

et al. 2020

Sci Rep

Neoadjuvant chemotherapy (NAC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) will be the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) patients. However, many patients fail to receive CC for multiple reasons. We aimed to investigate long-term survival outcomes and toxicities in these patients with NPC treated with additional NAC plus concurrent chemoradiotherapy (CCRT) or IMRT alone. In total, 1,378 previously untreated, newly diagnosed locoregionally advanced NPC patients receiving NAC plus IMRT with or without CC were retrospectively reviewed. We used a propensity score-matched (PSM) method with 1:1 matching to identify paired patients according to various covariates. Survival outcomes and toxicities were compared between the two groups. In total, 288 pairs were identified. With a median follow-up of 86 (range: 8-110) months, the estimated 5-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival rates in patients treated with NAC plus CCRT vs. NAC plus IMRT alone were 96.1% vs. 94.7% (P = 0.201), 93.7% vs. 89.8% (P = 0.129), 91.3% vs. 85.1% (P = 0.024), and 93.0% vs. 90.6% (P = 0.362), respectively. Multivariate analysis showed that CC omission was a prognostic factor for worse PFS. In a subgroup analysis, PFS did not differ significantly between two groups of female patients or aged <60 years or stage T1-2 or stage N0-1 disease. However, fewer acute complications were observed in the NAC plus IMRT alone group. NAC with IMRT alone confers similar survival rates and less acute toxicities. Specifically, NAC plus IMRT alone may be enough for female patients <60 years with stage T1-2 or stage N0-1. However, a prospective randomised trial is needed to validate these results.

Section: Discussionmentioning

confidence: 99%

Influence of concurrent chemotherapy on locoregionally advanced nasopharyngeal carcinoma treated with neoadjuvant chemotherapy plus intensity-modulated radiotherapy: A retrospective matched analysis

Jiang

et al. 2020

Sci Rep

“…Though equal therapeutic effects were observed, NACT plus IMRT decreased 10%‐15% of grade 3/4 adverse reactions, including MS, OM, XS and hearing loss . A study by OuYang et al achieved analogous results in NPC patients with stage II‐IVB disease . Lin et al and Liu et al further analyzed patients diagnosed with stage II‐IVB NPC and treated with NACT.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2019

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.

“…Although there was no prospective randomized trial published investigating the therapeutic value of IC followed by IMRT, retrospective studies and meta-analyses had shown high efficacy with low toxicities [20][21][22][23][24] in patients with LA-NPC. Lin et al suggested that IC plus IMRT resulted in superb 3-year PFS, OS, LRRFS, and DMFS.…”

Section: Discussionmentioning

confidence: 99%

“…Another propensity-matched study retrospectively analyzing 396 patients to investigate the efficacy of IC plus IMRT and CCRT in LA-NPC also observed no significant survival differences. 23 of grades 3 or 4 nausea-vomiting and leukopenia. 24 A metaanalysis analyzing 8 studies and 2605 patients showed IC plus RT achieved similar PFS, OS, LRRFS, and DMFS as IC plus CCRT and resulted in less hematological toxicities during radiation.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19] Previous studies showed that IC followed by IMRT alone provided comparable efficacy to IC plus CCRT, [20][21][22] as well as CCRT with or without adjuvant chemotherapy (AC). 21,23,24 Moreover, the toxicities of IC plus IMRT are significantly lower. 20,22,24 Docetaxel plus cisplatin (TP) as an IC regimen for LA-NPC has been shown by a phase 2 study.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sequential induction chemotherapy plus intensity‐modulated radiotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: the three‐year report of a phase II, single center, randomized, non‐inferiority trial

Cai

et al. 2021

Cancer Medicine