Comparison of Long-term Efficacy of IMRT plus Concurrent Chemotherapy Versus Neoadjuvant Chemotherapy Followed by IMRT plus Concurrent Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma
-
摘要:目的
比较局部中晚期鼻咽癌诱导化疗+IMRT同期化疗与IMRT同期化疗的远期疗效。
方法诱导化疗+同期放化疗组（诱导组）118例，同期放化疗组（同期组）106例。诱导化疗方案为TP（多西他赛+顺铂）或PF（氟尿嘧啶+顺铂），同期化疗全部采用单药顺铂方案，全组病例均接受调强放疗。Kaplan-Meier法计算生存率，Log rank检验比较组间生存曲线。
结果诱导组与同期组5年OS、DFS、DMFS、RFS分别为83.9%和82.1%（P=0.768），86.1%和79.8%（P=0.216），89.5%和84.5%（P=0.264）,96.4%和90.8%（P=0.114）。亚组分析显示对于T晚期（T3-4N0-1）或N晚期（T1-4N2-3）的病例，诱导化疗均未明显提高OS、DFS、DMFS、RFS。两种诱导化疗方案TP与PF比较差异也无统计学意义。诱导组的血液系统不良反应及消化道不良反应较同期组明显增加。
结论诱导化疗的使用未明显提高局部中晚期鼻咽癌的远期生存率，且血液系统、消化道等不良反应明显增加。
Abstract:ObjectiveTo compare the long-term efficacy between two chemoradiotherapy regimens in locoregionally advanced nasopharyngeal carcinoma (LANPC) patients treated with intensity-modulated radiotherapy (IMRT): neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) versus CCRT alone.
MethodsNACT followed by CCRT (NACT+CCRT group,n=118) and CCRT alone (CCRT group,n=106) . The NACT+CCRT group received TP(docetaxel and cisplatin) or PF(cisplatin and 5-fluorouracil). All patients were treated with cisplatin concurrently with IMRT. The survival rates were assessed by Kaplan-Meier analysis,and the survival curves were compared using Log rank test.
ResultsThere was no significant difference between the NACT+CCRT group and CCRT group in 5-year OS(83.9% vs. 82.1%,P=0.768) ,DFS(86.1% vs. 79.8%,P=0.216) ,DMFS(89.5% vs. 84.5%,P=0.264) or RFS(96.4% vs. 90.8%,P=0.114) . Subgroup analysis showed that compared with CCRT,NACT+CCRT did not significantly improve 5-year OS,RFS,DMFS,DFS in patients with advanced T-stage disease (T3-4N0-l) or advanced N-stage disease (T1-4N2-3) . There was no significant difference in the survival between the induction TP and induction PF. There were significantly higher numbers of individuals with hematologic toxicity and gastrointestinal reactions in the NACT+CCRT group than those in the CCRT group .
ConclusionNACT does not significantly improve the long-term survival in the patients with LANPC moreover,it increases the risk of severe hematologic toxicity and gastrointestinal reactions.
-
-
表 1 224例局部中晚期鼻咽癌患者临床特征分布（例）
Table 1 Characteristics of 224 patients with locoregionally advanced nasopharyngeal carcinoma (n)
下载: 导出CSV
表 2 224例局部中晚期鼻咽癌不同治疗模式的远期疗效比较及亚组分析
Table 2 Summary of long-term survival and subset analyses in 224 patients with locoregionally advanced NPC between NACT+CCRT and CCRT group
下载: 导出CSV
表 3 224例局部中晚期鼻咽癌患者不同治疗模式的不良反应分布与比较
Table 3 Treatment-related toxicities in 224 patients with locoregionally advanced NPC between NACT+CCRT and CCRT group
下载: 导出CSV
-
[1] 冯梅, 范子煊, 黎杰, 等. 582例鼻咽癌调强放疗5年远期疗效及 预后分析[J].中华放射肿瘤学杂志, 2011, 20(5): 369-73. [Feng M, Fang ZX, Li J, et al. Long-term results and prognostic factors in 582 nasopharyngeal carcinoma treated by Intensitymodulated radiotherapy[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2011, 20(5): 369-73.] [1] 冯梅,范子煊,黎杰,等. 582例鼻咽癌调强放疗5年远期疗效及预后分析[J].中华放射肿瘤学杂志,2011,20(5): 369-73. Feng M,Fang ZX,Li J,et al. Long-term results and prognostic factors in 582 nasopharyngeal carcinoma treated by Intensitymodulated radiotherapy[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi,2011,20(5): 369-73.
[2] 林少俊,潘建基,韩露,等. 鼻咽癌小靶区调强放疗及化疗的远期疗效分析[J]. 中华放射肿瘤学杂志,2013,22(5): 378-82. Lin SJ,Pan JJ,Han L,et al. Long-term outcome of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiotherapy and chemotherapy[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi,2013,22(5): 378-82.
[2] 林少俊, 潘建基, 韩露, 等. 鼻咽癌小靶区调强放疗及化疗的远 期疗效分析[J]. 中华放射肿瘤学杂志, 2013, 22(5): 378-82. [Lin SJ, Pan JJ, Han L, et al. Long-term outcome of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiotherapy and chemotherapy[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2013, 22(5): 378-82.] [3] 苏胜发,赵充,韩非,等. 鼻咽癌适形调强放疗远期疗效分析[J].中华肿瘤防治杂志,2013,20(11): 853-8. http://www.cnki.com.cn/Article/CJFDTOTAL-QLZL201311018.htm Su SF,Zhao C,Han F,et al. Long-term outcome of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J]. Zhonghua Zhong Liu Fang Zhi Za Zhi,2013,20(11): 853-8. http://www.cnki.com.cn/Article/CJFDTOTAL-QLZL201311018.htm
[3] 苏胜发, 赵充, 韩非, 等. 鼻咽癌适形调强放疗远期疗效分析[J]. 中华肿瘤防治杂志, 2013, 20(11): 853-8. [Su SF, Zhao C, Han F, et al. Long-term outcome of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy[J]. Zhonghua Zhong Liu Fang Zhi Za Zhi, 2013, 20(11): 853-8.] [4] Sun X, Zeng L, Chen C, et al. Comparing treatment outcomes of different chemotherapy, sequences during intensitymodulated radiotherapy for advanced N-stage nasopharyngeal carcinoma patients[J]. Radiat Oncol, 2013, 8: 265. [4] Sun X,Zeng L,Chen C,et al. Comparing treatment outcomes of different chemotherapy,sequences during intensitymodulated radiotherapy for advanced N-stage nasopharyngeal carcinoma patients[J]. Radiat Oncol,2013,8: 265. doi: 10.1186/1748-717X-8-265
[5] Song Y, Wang W, Tao G, et al. Survival benefit of induction chemotherapy in treatment for locally advanced nasopharyngeal carcinoma-A time-to-event meta-analysis[J]. Oral Oncol, 2015, 51(8): 764-9. [5] Song Y,Wang W,Tao G,et al. Survival benefit of induction chemotherapy in treatment for locally advanced nasopharyngeal carcinoma-A time-to-event meta-analysis[J]. Oral Oncol,2015,51(8): 764-9. doi: 10.1016/j.oraloncology.2015.05.006
[6] Fountzilas G,Ciuleanu E,Bobos M,et al. Induction chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma:a randomized phase Ⅱstudy conducted by the Hellenic Cooperative Oncology Group(HeCOG)with biomarker evaluation[J]. Ann Oncol,2012,23(2): 427-35. doi: 10.1093/annonc/mdr116
[6] Fountzilas G, Ciuleanu E, Bobos M, et al. Induction chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma:a randomized phase II study conducted by the Hellenic Cooperative Oncology Group(HeCOG)with biomarker evaluation[J]. Ann Oncol, 2012, 23(2): 427-35. [7] Liang ZG, Zhu XD, Tan AH, et al. Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: metaanalysis of 1,096 patients from 11 randomized controlled trials[J]. Asian Pac J Cancer Prev, 2013, 14(1): 515-21. [7] Liang ZG, Zhu XD, Tan AH,et al. Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: meta-analysis of 1,096 patients from 11 randomized controlled trials[J]. Asian Pac J Cancer Prev, 2013,14(1): 515-21. doi: 10.7314/APJCP.2013.14.1.515
[8] Qiu WZ, Huang PY, Shi JL, et al. Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma: a retrospective controlled study[J]. Chin J Cancer, 2016, 35(1): 2. [8] Qiu WZ,Huang PY,Shi JL,et al. Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma: a retrospective controlled study[J]. Chin J Cancer,2016,35(1): 32-40. doi: 10.1186/s40880-016-0094-2
[9] 关莹, 孙学明, 曾雷, 等. 局部晚期鼻咽癌诱导化疗加IMRT同 期化疗与IMRT同期化疗的远期疗效比较[J].中华放射肿瘤 学杂志, 2014, 23(2): 131-4. [Guan Y, Sun XM, Zeng L, et al. Comparison of long-term efficacy between intensity-modulated radiotherapy with concurrent chemotherapy and neoadjuvant chemotherapy followed by intensity-modulated radiotherapy with concurrent chemotherapy in patients with locally advanced nasopharyngeal[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2014, 23(2): 131-4.] [9] 关莹,孙学明,曾雷,等. 局部晚期鼻咽癌诱导化疗加IMRT同期化疗与IMRT同期化疗的远期疗效比较[J].中华放射肿瘤学杂志,2014,23(2): 131-4. http://www.cnki.com.cn/Article/CJFDTOTAL-HBYK201501016.htm Guan Y,Sun XM,Zeng L,et al. Comparison of long-term efficacy between intensity-modulated radiotherapy with concurrent chemotherapy and neoadjuvant chemotherapy followed by intensity-modulated radiotherapy with concurrent chemotherapy in patients with locally advanced nasopharyngeal[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi,2014,23(2): 131-4. http://www.cnki.com.cn/Article/CJFDTOTAL-HBYK201501016.htm
[10] Chen L, Hu CS, Chen XZ, et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial[J]. Lancet Oncol, 2012, 13(2): 163-71. [10] Chen L,Hu CS,Chen XZ,et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial[J]. Lancet Oncol,2012,13(2): 163-71. doi: 10.1016/S1470-2045(11)70320-5
[11] Liang ZG, Zhu XD, Zhou ZR, et al. Comparison of concurrent chemoradiotherapy followed by adjuvant chemotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of 793 patients from 5 randomized controlled trials[J]. Asian Pac J Cancer Prev, 2012, 13(11): 5747-52. [11] Liang ZG,Zhu XD,Zhou ZR,et al. Comparison of concurrent chemoradiotherapy followed by adjuvant chemotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of 793 patients from 5 randomized controlled trials[J]. Asian Pac J Cancer Prev,2012,13(11): 5747-52. doi: 10.7314/APJCP.2012.13.11.5747
[12] Wee CW, Keam B, Heo DS, et al. Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy[J]. Radiat Oncol J, 2015, 33(2): 98-108. [12] Wee CW, Keam B, Heo DS,et al. Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy[J]. Radiat Oncol J, 2015,33(2): 98-108. doi: 10.3857/roj.2015.33.2.98
[13] Liang XX, Li Q, Su Z,et al. Significant prognostic impact of chemoradiotherapy-induced hemoglobin decrease on treatment outcomes of nasopharyngeal carcinoma[J]. J Cancer,2015,6(6): 502-10. doi: 10.7150/jca.11403
[13] Liang XX, Li Q, Su Z, et al. Significant prognostic impact of chemoradiotherapy-induced hemoglobin decrease on treatment outcomes of nasopharyngeal carcinoma[J]. J Cancer, 2015, 6(6): 502-10. [14] Du XJ, Tang LL, Chen L, et al. Neoadjuvant chemothe r a py i n loca ll y a d va nced naso pha r y n gea l ca r ci noma: rrent chemotherapy combined with intensity-modulated radiotherapy[J]. Sci Rep, 2015, 5: 16664. [14] Du XJ, Tang LL, Chen L,et al. Neoadjuvant chemoth-erapy in locally advanced nasopharyngeal carcinoma: rrent chemotherapy combined with intensity-modulated radiotherapy[J]. Sci Rep, 2015,5: 16664. doi: 10.1038/srep16664
[15] Kong L, Hu C, Niu X, et al. Neoadjuvant chemotherapy follow ed by concurrent for locoregionally advanced nasopharyngeal carcinoma: interim results from 2 prospective phase 2 clinical trials[J]. Cancer, 2013, 119(23): 4111-8. [15] Kong L, Hu C,Niu X, et al. Neoadjuvant chemotherapy followed by concurrent for locoregionally advanced nasopharyngeal carcinoma: interim results from 2 prospective phase 2 clinical trials[J]. Cancer,2013,119(23): 4111-8. doi: 10.1002/cncr.28324
[16] Huang Z, Feng J, Li S, et al. Is the Neoadjuvant Docetaxel,Cislatin and 5-Fluorouraeil regimen superior to classic Cisplatin and Fluorouraeil for locoregionally advanced nasopharyngeal carcinoma?[J]. J Cancer Res Updates, 2013, 2(4): 297-305. [16] Huang Z,Feng J,Li S,et al. Is the Neoadjuvant Docetaxel,Cis-latin and 5-Fluorouraeil regimen superior to classic Cisplatin and Fluorouraeil for locoregionally advanced nasopharyngeal carcinoma?[J]. J Cancer Res Updates,2013,2(4): 297-305.
[17] Ma J, Chen NY, Zhang N, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: preliminary results of a phase 3 multicentre randomised controlled trial[J]. Eur J Cancer, 2014: e3-4. [17] Ma J,Chen NY,Zhang N,et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: preliminary results of a phase 3 multicentre randomised controlled trial[J]. Eur J Cancer,2014: e3-4.
[18] Zheng W,Qiu S,Huang L,et al. Is Gemcitabine and Cisplatin Induction Chemotherapy Superi-r in Locoregionally Advanced Nasopharyngeal Carcinoma?[J]. Pak J Med Sci,2015,31(4): 781-6.
[18] Zh e n g W, Qi u S , Hu a n g L, e t a l . I s G e m c i t a b i n e a n d C i s p l a t i n I n d u c t i o n C h e m o t h e r a p y S u p e r i - r in Locoregionally Advanced Nasopharyngeal Carcinoma?[J]. Pak J Med Sci, 2015, 31(4): 781-6.
计量
- 文章访问数: 1503
- HTML全文浏览量: 329
- PDF下载量: 611
