Clinical Research Papers:
Comparing the efficacy of induction-concurrent with concurrent-adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis
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Li-Rong Wu1,*, Xue-Song Jiang1,* Xue Song1, Hong-Liang Yu1, Yan-Xin Fan1, Fei-Jiang Wang1, Sheng-Fu Huang1, Wen-Jie Guo1, Xia He1 and Ju-Ying Liu1
1Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing 210009, China
*These authors contributed equally to this work
Xia He, email: [email protected]
Ju-Ying Liu, email: [email protected]
Keywords: nasopharyngeal carcinoma, locoregionally advanced, induction chemotherapy, adjuvant chemotherapy, intensity-modulated radiotherapy
Received: June 21, 2017 Accepted: August 06, 2017 Published: August 22, 2017
Purpose: This study aimed to compare the efficacy of induction-concurrent (IC-CCRT) with concurrent-adjuvant (CCRT-AC) chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated by intensity-modulated radiotherapy (IMRT).
Materials and Methods: Data on 834 patients with newly diagnosed, non-metastatic stage III-IVA (except T3N0) NPC receiving either IC-CCRT or CCRT-AC between July, 2004 and December, 2014 were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance prognostic factors and match patients. Survival outcomes of matched patients between IC-CCRT and CCRT-AC were compared.
Results: The median follow-up duration is 45.2 months (range, 1.07–145.4 months). Overall, 309 pairs were selected by PSM. Univariate analysis revealed the CCRT-AC group achieved significantly higher 3-year DFS (83.9% vs. 78.7 %; P = 0.014) and OS (87.6% vs. 87.0%; P = 0.031). Multivariate analysis also identified treatment group (IC-CCRT vs. CCRT-AC) as an independent prognostic factor for 3-year DFS (HR, 1.546; 95% CI, 1.113–2.149; P = 0.009) and OS (HR, 1.487; 95% CI, 1.035–2.136; P = 0.032). Subgroup analysis revealed IC-CCRT was a protective factor for DMFS (HR, 0.145; 95% CI, 0.043–0.488; P = 0.002) in stage III disease; however, it could adversely affected DFS (HR, 2.009; 95% CI, 1.316–3.065; P = 0.001), OS (HR, 1.671; 95% CI, 1.060–2.636; P = 0.027) and DMFS (HR, 1.986; 95% CI, 1.155–3.416; P = 0.013) in stage IVA disease.
Conclusions: CCRT-AC may be a more effective treatment modality in patients with stage IVA NPC disease, while IC-CCRT was superior in stage III disease.
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