Outcomes of adding induction chemotherapy to concurrent chemoradiotherapy for stage T3N0-1 nasopharyngeal carcinoma: a propensity-matched study
Authors Lan XW, Xiao Y, Zou XB, Zhang XM, Ouyang PY, Xie FY
Received 4 February 2017
Accepted for publication 3 May 2017
Published 1 August 2017 Volume 2017:10 Pages 3853—3860
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 3
Editor who approved publication: Dr Ingrid Espinoza
Xiao-Wen Lan,1,2,* Yao Xiao,1,* Xue-Bin Zou,3,* Xiao-Min Zhang,1 Pu-Yun OuYang,1 Fang-Yun Xie1
1Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 2Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 3Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China
*These authors contributed equally to this work
Objective: Our objective was to examine whether adding induction chemotherapy to concurrent chemoradiotherapy improved survival in stage III nasopharyngeal carcinoma (NPC) patients, especially in low-risk patients at stage T3N0-1.
Materials and methods: We retrospectively analyzed 687 patients with stage T3N0-1 NPC treated with intensity-modulated radiation therapy (IMRT) plus concurrent chemotherapy (CC) with or without induction chemotherapy (IC). Propensity score matching (PSM) method was used to select 237 pairs of patients from two cohorts. Overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) were assessed by using the Kaplan–Meier method, log-rank test, and Cox regression analysis.
Results: No significant survival differences were observed between IC plus CC and CC cohorts with similar 4-year OS (91.7% vs 92.6%, P=0.794), LRFS, (92.7% vs 96.8%, P=0.138), DMFS (93.5% vs 94.3%, P=0.582), and PFS (87.5% vs 91.1%, P=0.223). In a univariate analysis, lower Epstein–Barr virus deoxyribonucleic acid (EBV DNA; <4,000 copies/mL) significantly improved 4-year DMFS (95.5% vs 91.6%, P=0.044) compared with higher EBV DNA (≥4,000 copies/mL). No factors were associated with 4-year OS, LRFS, DMFS, and PFS in a multivariate analysis. IC plus CC group experienced higher rates of grade 3–4 leucopenia (P<0.001) and neutropenia (P<0.001).
Conclusion: The addition of IC to CC in stage T3N0-1 NPC patients treated with IMRT did not significantly improve their survival. The IC group experienced higher rates of grade 3–4 hematological toxicities. Therefore, further investigation is required.
Keywords: nasopharyngeal carcinoma, induction chemotherapy, intensity-modulated radiation therapy, propensity score matching, stage T3N0-1
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