To explore the role of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) and CCRT plus adjuvant chemotherapy (AC) in locoregionally advanced nasopharyngeal carcinoma (LANPC).
The propensity score-matched (PSM) method was adopted to balance variables. We identified independent prognostic factors using Cox regression analysis and compared outcomes between two chemotherapy treatment combinations for patients in different subgroups.
A total of 550 patients were selected by one-to-two PSM. Survival outcomes for the matched data set indicated that the ICÂ +Â CCRT group achieved higher 5-year overall survival (OS; 89.3% vs 85.3%, PÂ =Â 0.119), failure-free survival (FFS; 80.2% vs 79.0%, PÂ =Â 0.722) and distant metastasis-free survival (DMFS; 87.4% vs 84.4%, PÂ =Â 0.322) compared with CCRTÂ +Â AC, although this was statistically non-significant. Subgroup analysis revealed that ICÂ +Â CCRT was associated with significantly improved OS (Hazard ratio [HR]Â =Â 2.68, 95% Confidence interval [CI]Â =Â 1.16-6.22, PÂ =Â 0.017), FFS (HRÂ =Â 1.94, 95% CIÂ =Â 1.06-3.57, PÂ =Â 0.029) and locoregional relapse-free survival (LRRFS; HRÂ =Â 2.63, 95% CIÂ =Â 1.04-6.68, PÂ =Â 0.034) in T3 disease. Moreover, this combination of treatment could significantly prolong OS (HRÂ =Â 3.72, 95% CIÂ =Â 1.41-9.80, PÂ =Â 0.004) in N2 disease. However, the superiority of CCRTÂ +Â AC was only observed in LRRFS (HRÂ =Â 0.18, 95% CI 0.04-0.79, PÂ =Â 0.010) for the T4 subgroup.
ICÂ +Â CCRT should be strongly considered by patients with LANPC, especially those with T3 or N2 disease.
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
References
PubMed