Induction chemotherapy plus IMRT alone versus induction chemotherapy plus IMRT-based concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a retrospective cohort study

Background

To evaluate the value of concurrent chemotherapy after induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiation therapy (IMRT), we performed this retrospective cohort study to compare the efficiency and toxicities of induction chemotherapy plus IMRT alone (IC + RT) versus induction chemotherapy plus IMRT-based concurrent chemoradiotherapy (IC + CCRT).

Method

We analyzed data from patients with locoregionally advanced NPC (stage III–IVb) who were treated at the West China hospital between January 2008 and December 2014. Patients received docetaxel, cisplatin, and 5-fluorouracil (TPF) IC followed by IMRT alone (IC + RT group) or IMRT plus cisplatin concurrent chemotherapy (IC + CCRT group). The main endpoint was overall survival (OS), which was evaluated by the Kaplan–Meier method and log-rank test. Multivariate Cox proportional hazard analysis was used to identify potential independent prognostic factors. Treatment-associated toxicities were compared between groups using the Chi squared test.

Results

A total of 78 patients treated with IC + RT and 76 with IC + CCRT were analyzed. The median follow-up time was 59 months (range: 7–108 months). There was no difference between patients treated with IC + RT and IC + CCRT in terms of 3-year OS (89.0% versus 88.0%, p = 0.286), progression-free survival (76.8% versus 80.0%, p = 0.142), locoregional recurrence-free survival (87.1% versus 90.5%, p = 0.156), or distant metastasis-free survival (83.6% versus 82.6%, p = 0.567). Treatment (IC + RT versus IC + CCRT) was not an independent prognostic factor for OS (HR 1.425, 95% CI 0.698–2.908; p = 0.331). IC + CCRT was associated with a higher incidence of grade 3–4 neutropenia than IC + RT during radiotherapy (11.8% versus 1.3%, p = 0.020).

Conclusion

IC plus IMRT alone achieves similar patient survival outcomes as IC plus IMRT-based concurrent chemoradiotherapy, and has a lower incidence of toxicity.