Objective To investigate and compare the prognostic effects of different courses of neoadjuvant chemotherapy (NCT) on patients with clinical stage N2-3 locally advanced nasopharyngeal carcinoma.

Methods We retrospectively reviewed the clinical data of 270 patients with locally advanced nasopharyngeal carcinoma (cT1-4N2-3) who were treated with NCT followed by concurrent chemoradiotherapy (CCRT) or only CCRT from 2012 to 2013. Patients were classified into three groups: NCT≥3 (n=84, 31.1%), NCT=2 (n=106, 39.3%) and NCT=0 (n=80, 29.6%). The survival rate was calculated by Kaplan-Meier and examined by Log rank test. Univariate and multivariate analyses of the distant metastasis free survival (DMFS) factors was conducted using Cox proportional hazard models.

Results The median follow-up time was 63 months (6-75 months). For the whole group, 5-year overall survival (5-OS), 5-year disease free survival (5-DFS), 5-year local recurrence free survival (5-LRFS) and 5-year distant metastasis free survival (5-DMFS) were 78.4%, 77.8%, 97.7% and 79.5%, respectively. For NCT≥3, NCT=1-2 and NCT=0 groups, 5-OS were 88.1%, 78.8% and 73.5%, respectively (P=0.03); 5-DFS were 89.3%, 74.0% and 72.3%, respectively (P=0.021); 5-DMFS were 89.3%, 76.6% and 74.5%, respectively (P=0.031); 5-LRFS had no statistically significant difference among the three groups (P=0.535). Univariate and multivariate analyses suggested that neoadjuvant chemotherapy course, N stage and age were all independent prognostic factors.

Conclusion More than three courses of NCT before CCRT could improve overall survival and reduce distant metastases rate in stage N2-3 locally advanced nasopharyngeal carcinoma patients.