Clinical effects of EMRT combined with EGFR monoclonal antibody, concurrent chemoradiotherapy, and IMRT alone in nasopharyngeal carcinoma patients: a retrospective case-control study

Objective: To compare the treatment outcomes and toxicities in nasopharyngeal carcinoma patients who receive intensity-modulated radiotherapy (IMRT) combined with epidermal growth factor receptor (EGFR) monoclonal antibody, IMRT with concurrent chemotherapy, and IMRT alone. Methods: Sixty-eight previously untreated patients with stage II-IV_b nasopharyngeal carcinoma (NPC) who received IMRT combined with cetuximab or nimotuzumab from January 2008 to September 2012 were included in BRT group; the BRT group was matched with 136 patients treated with concurrent chemoradiotherapy (CCRT) and 136 patients treated with IMRT alone at a ratio of 1 : 2 using SAS software. The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Prognostic factors were analyzed by the Cox model. Results: The sample sizes of the BRT group, IMRT group, and CCRT group were 14, 69, 47, respectively. The 3-year overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) of all patients were 91.2%, 80.2%, 93.1%, and 87.2%, respectively. The 3-year OS rates of BRT group, IMRT group, and CCRT group were 91.9%, 92.1%, and 89.9%, respectively (P = 0.379); the 3-year DFS rates of BRT group, IMRT group, and CCRT group were 82.1%, 77.9%, and 81.6%, respectively (P = 0.594); the 3-year LRC rates of BRT group, IMRT group, and CCRT group were 98.2%, 90.6%, and 93.0%, respectively (P = 0.249); the 3-year DMFS rates of BRT group, IMRT group, and CCRT group were 85.2%, 85.2%, and 90.3%, respectively (P = 0.383). Multivariate prognostic analysis showed that T stage and concurrent use of EGFR monoclonal antibody were influential factors for LRC (P = 0.034 and 0.032). Conclusions: IMRT alone yields a good treatment outcome in NPC patients. Although there were no significant differences in OS between the three groups, the BRT group showed an increasing trend in LRC. (authors)