Comparison of Long-term Efficacy of IMRT plus Concurrent Chemotherapy Versus Neoadjuvant Chemotherapy Followed by IMRT plus Concurrent Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma

Objective To 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.

Methods NACT 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.

Results  There 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 .

Conclusion  NACT 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.