Yi-Yuan Dong1,2, Chun Xiang3, Jian-Xun Lu4, Yi-Xin Su5, Yu-Fei Pan6, Rui Cai1, Rong-Jun Zhang1, Zhuo-Kai He1, Mei-Lian Liu1, Hui Huang1, Xue Bai1, Hua-Ying Tang1, Yun-Hua Shi1, Yan Wang1, Wei Jiang7. 1. Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China. 2. Department of Otorhinolaryngology, Guilin Medical University Affiliated Hospital, 15 Lequn Road, 541001, Guilin, PR China. 3. Department of Otorhinolaryngology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, PR China. 4. Department of Oncology, Affiliated Hospital of Youjiang Medical University for Nationalities, 18 Zhongshan Second Road, 533000, Baise, PR China. 5. Department of Radiation Oncology, Lingshan People's Hospital, 1 Zhongxiu Road, 535400, Lingshan, PR China. 6. Department of Radiation Oncology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, PR China. 7. Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China. weijiang@glmc.edu.cn.
Abstract
PURPOSE: The benefit of adjuvant chemotherapy (AC) in locoregionally advanced nasopharyngeal carcinoma (NPC) is controversial. This study compared concurrent chemoradiotherapy plus AC (CCRT/AC) with CCRT. METHODS: Pair-matched analysis based on eight clinicopathological features of 244 patients treated with platinum-based CCRT/AC or CCRT alone was performed. Survival outcomes were assessed using the Kaplan-Meier method and log-rank test. Toxicities and response rates were compared using Fisher's exact test. RESULTS: Four-year overall survival, progression-free survival, distant failure-free survival, and locoregional failure-free survival were 72 %, 61 %, 71 %, and 81 %, respectively, for the CCRT arm, compared to 74 % (hazard ratio, HR 0.89; 95 % confidence interval, CI 0.64-1.23; P = 0.474), 62 % (HR 0.91, 95 % CI 0.68-1.20, P = 0.489), 73 % (HR 0.84, 95 % CI 0.59-1.18, P = 0.316), and 84 % (HR 0.84, 95 % CI 0.52-1.24, P = 0.323), respectively, for the CCRT/AC arm. Cox multivariate regression analysis demonstrated AC was not an independent prognostic factor. Overall, there was a higher incidence of grade 3-4 toxicities in the CCRT/AC arm. The most common grade 3-4 adverse events in the CCRT/AC arm were vomiting (27 %), nausea (43 %), leukopenia/neutropenia (23 %), thrombocytopenia (8.8 %), and anemia (6.2 %). CONCLUSION: Addition of AC to CCRT increased toxicities but did not improve survival in locoregionally advanced NPC.
PURPOSE: The benefit of adjuvant chemotherapy (AC) in locoregionally advanced nasopharyngeal carcinoma (NPC) is controversial. This study compared concurrent chemoradiotherapy plus AC (CCRT/AC) with CCRT. METHODS: Pair-matched analysis based on eight clinicopathological features of 244 patients treated with platinum-based CCRT/AC or CCRT alone was performed. Survival outcomes were assessed using the Kaplan-Meier method and log-rank test. Toxicities and response rates were compared using Fisher's exact test. RESULTS: Four-year overall survival, progression-free survival, distant failure-free survival, and locoregional failure-free survival were 72 %, 61 %, 71 %, and 81 %, respectively, for the CCRT arm, compared to 74 % (hazard ratio, HR 0.89; 95 % confidence interval, CI 0.64-1.23; P = 0.474), 62 % (HR 0.91, 95 % CI 0.68-1.20, P = 0.489), 73 % (HR 0.84, 95 % CI 0.59-1.18, P = 0.316), and 84 % (HR 0.84, 95 % CI 0.52-1.24, P = 0.323), respectively, for the CCRT/AC arm. Cox multivariate regression analysis demonstrated AC was not an independent prognostic factor. Overall, there was a higher incidence of grade 3-4 toxicities in the CCRT/AC arm. The most common grade 3-4 adverse events in the CCRT/AC arm were vomiting (27 %), nausea (43 %), leukopenia/neutropenia (23 %), thrombocytopenia (8.8 %), and anemia (6.2 %). CONCLUSION: Addition of AC to CCRT increased toxicities but did not improve survival in locoregionally advanced NPC.
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