Addition of 5-fluorouracil to first-line induction chemotherapy with docetaxel and cisplatin before concurrent chemoradiotherapy does not improve survival in locoregionally advanced nasopharyngeal carcinoma
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Wang Fangzheng1,2,3,*, Jiang Chuner4,*, Wang Lei1,2, Yan Fengqin1,2, Ye Zhimin1,2, Sun Quanquan1,2, Liu Tongxin1,2, Xu Min5, Wu Peng6, Long Bin7, Rihito Aizawa8, Masoto Sakamoto3 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 Nuclear Medicine, 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, 606-8507, Kyoto, Japan
*These authors contributed equally to this work
Fu Zhenfu, email: [email protected]
Keywords: nasopharyngeal carcinoma, induction chemotherapy, concurrent chemoradiotherapy, toxicity, prognosis
Received: June 05, 2017 Accepted: July 25, 2017 Published: August 07, 2017
Although a multicenter, randomized study indicated that induction chemotherapy (IC) with docetaxel/cisplatin/fluorouracil (TPF) before concurrent chemoradiotherapy (CCRT) improves survival outcomes, it remains unclear whether TPF is the best IC regimen for treating locoregionally advanced nasopharyngeal carcinoma (NPC). Our aim was to compare the efficacy and toxicities of TPF vs. docetaxel/cisplatin (TP) IC followed by CCRT in patients with locoregionally advanced NPC. One hundred thirty-two patients with locoregionally advanced NPC received 21-day cycles of IC with either TPF or TP. Both were followed by intensity-modulated radiotherapy concurrent with the cisplatin treatment every 3 weeks. Three-year rates of locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival were respectively 96.4%, 87.7%, 86.0%, and 94.7% for patients in the TPF arm patients and 90.3%, 91.9%, 85.2%, and 92.0% for patients in the TP arm. There were no differences in survival between the two arms. Multivariate analysis revealed the IC regimen was not an independent prognostic factor for any survival outcome. However, patients in the TP arm experienced fewer grade 3/4 toxicities. In sum, IC with docetaxel and cisplatin is associated with similar efficacy and less toxicity than the TPF regimen. Addition of fluorouracil to docetaxel plus cisplatin IC is therefore not recommended for patients with locoregionally advanced NPC.
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