298P - Long-term complication and outcomes after induction chemotherapy with TPF followed by chemoradiotherapy for nasopharyngeal cancer

Background

Although the acute toxicities during induction TPF in head and neck cancers are well known, there has been little studied about the long term complications including of outcomes in nasopharyngeal cancer (NPC). The purpose of this study is to evaluate the long term complications and survival outcomes in patients with locally advanced NPC treated with induction TPF followed by CRT.

Methods

From 2004 to 2016, 244 patients were diagnosed as NPC. Among them, 104 patients who completed the 3 cycles of TPF (docetaxel 75 mg/m² and cisplatin 75/m² day 1, plus fluorouracil 1000 mg/m² days 1–4, every 3 wks) followed by CRT were evaluated. During CRT, cisplatin was given as either a weekly or 3 weeks regimen and RT was performed at 65–70 Gy. After completing TPF and CRT, follow up imaging and regular examination was checked by ENT specialist.

Results

The median follow-up duration was 60 months (range, 13-135). 5Y OS rate and 3Y PFS rate were 88.9±3.7% (95%CI 81.65-96.15) and 80.4±4.5 (95%CI 71.58-89.22). PFS was significantly associated with TNM (p = 0.001), especially N stage (N3, 3Y-PFS 42.9%, p = 0.001). The response after induction chemotherapy and postop CRT were significantly associated with PFS and OS. ENT complications such as hearing impairment, chronic infection, ear drum perforation were shown in 31 patients (30%) and renal impairment (Clcr≤60) was developed in 30 patients (30%). The incidence of both complications was significantly associated with age (>65 years, ENT Cx, p = 0.011, renal Cx, 0.032). However, age was not attenuate response rate or survival. The decreased Clcr before starting RT was associated with long term renal complication, and cumulative cisplatin dose did not affect treatment outcome. In addition, both ENT and renal toxicities were not associated with the radiation dose or cumulative cisplatin dose.

Conclusions

TPF followed by CCRT is an effective treatment scheme for advanced NPC. However, long term complications in ENT and decreased renal function were considerable, especially in elderly. Therefore, careful observation and management are required for high risk patients and optimal cisplatin adjustment could be prevent renal complication without affecting the treatment outcomes.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.