While the combined modality treatment of concurrent chemoradiotherapy (CCRT) with or without adjuvant chemotherapy has now been accepted as the standard treatment for advanced Nasopharyngeal carcinoma (NPC), induction chemotherapy +concurrent chemoradiotherapy (ICRT) is commonly used as well. The prognosis of II NPC patients is favorable. We should be more mindful to living quality during/after treatment, length of hospital stay, treatment cost and so forth. Therefore, the purpose of this study is to contrast prognosis of stage II NPC patients underwent the following two treatment modalities: ICRT vs CCRT.
173 patients with American Joint Committee on Cancer 7th stage II NPC are included and divided into two groups: ICRT and CCRT. Induction chemotherapy consisted of 1 to 3 cycles of cisplatin plus fluorouracil or paclitaxel plus cisplatin. Concurrent chemotherapy includes cisplatin only. We retrospectively assess overall survival (OS), progression-free survival (PFS), locoregional free survival (LRFS) and distant metastasis free survival (DMFS).
With a median follow up of 64.7 months, no significant differences are found in grade 3–4 hematologic toxicity, liver dysfunction and renal impairment between ICRT and CCRT groups. Univariable analyses show adding induction chemotherapy to CCRT significantly decreases 5-year OS (87.9% vs 95.5%, P = 0.033), PFS (74.0% vs 86.1%, P = 0 .035), LRFS (80.0% vs 91.2%, P = 0.016), but there is no statistically significant difference in DMFS (87.1% vs 94.7%, P = 0.095). In multivariable analyses, we find the consistent results that induction chemotherapy is a negative factor associated with OS (HR of death =3.768, 95% CI = 1.117 to 12.709; P = 0.032), PFS (HR of progression = 2.156, 95% CI = 1.060 to 4.386; P = 0.034), LRFS (HR of locoregional relapse = 2.435, 95% CI = 1.009 to 5.874; P = 0.048) and also DMFS (HR of metastasis = 2.873, 95% CI = 1.005 to 8.211; P = 0.049), in stage II NPC patients.
In present study, we find that induction chemotherapy causes deleterious effect on stage II NPC patients. However, this is a retrospective study and the adverse effects of induction chemotherapy has not been previously reported. It warrants further investigation.
Clinical trial identification
Legal entity responsible for the study
Zhejiang Cancer Hospital.
Has not received any funding.
The authors indicated no potential conflicts of interest.
All authors have declared no conflicts of interest.