Gemcitabine/cisplatin induction chemotherapy before concurrent chemotherapy and intensity-modulated radiotherapy improves outcomes for locoregionally advanced nasopharyngeal carcinoma
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Wang Fangzheng1,2,3,*, Sun Quanquan1,2, Jiang Chuner4,*, Wang Lei1,2, Yan Fengqin1,2, Ye Zhimin1,2, Liu Tongxin1,2, Xu Min5, Wu Peng6, Jiang Haitao7, Rihito Aizawa8, Masoto Sakamoto3, Wang Yuezhen1,2 and Fu Zhenfu1,2
1Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China
2Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People’s Republic of China
3Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501, Japan
4Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China
5Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China
6Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China
7Department of Radiology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China
8Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
*These authors contributed equally to this work
Wang Fangzheng, email: [email protected]
Keywords: nasopharyngeal carcinoma, induction chemotherapy, intensity-modulated radiotherapy, concurrent chemotherapy, toxicity
Received: March 20, 2017 Accepted: May 14, 2017 Published: May 27, 2017
Addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CC) is an encouraging first-line treatment strategy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). We evaluated the clinical efficacy and toxicity of addition of gemcitabine plus cisplatin (GP) IC to intensity-modulated radiotherapy (IMRT) and CC for patients with locoregionally advanced NPC. At a median follow-up duration of 48 months (10–59 months), 4-year local relapse-free survival (LRFS) was 86.9%, regional relapse-free survival (RRFS) was 90.6%, distant metastasis-free survival (DMFS) was 79.8%, progression-free survival (PFS) was 77.0%, and overall survival (OS) was 81.9%. Univariate analysis revealed that T stage, N stage, clinical stage, and CC correlated with OS, while N stage and clinical stage correlated with PFS. In multivariate analysis, T4 was a prognostic indicator of poor OS and PFS, and N3 was a prognostic indicator of poor OS. Having received ≥ 2 cycles of IC was prognostic of better RRFS. During IC, grade 3–4 thrombocytopenia occurred in 10 patients, and grade 3–4 leukocytopenia was observed in 16 patients. Two patients developed mild liver dysfunction. These findings indicate that GP-based IC followed by CC has promising efficacy with acceptable toxicities.
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