Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in stage III-IVb nasopharyngeal carcinoma patients with Epstein-Barr virus DNA ≥4000 copies/ml: a matched study
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Shan-Shan Guo1,2,*, Lin-Quan Tang1,2,*, Qiu-Yan Chen1,2, Lu Zhang1,2, Li-Ting Liu1,2, Ling Guo1,2, Hao-Yuan Mo1,2, Dong-Hua Luo1,2, Pei-Yu Huang1,2, Yan-Qun Xiang1,2, Rui Sun1,2, Ming-Yuan Chen1,2, Lin Wang1,2, Xing Lv1,2, Chong Zhao1,2, Xiang Guo1,2, Ka-Jia Cao1,2, Chao-Nan Qian1,2, Mu-Shen Zeng1, Jin-Xin Bei1, Ming-Huang Hong1,3, Jian-Yong Shao1,4, Ying Sun1,5, Jun Ma1,5, Hai-Qiang Mai1,2
1Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
2Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
3Good Clinical Practice center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
4Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
5Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
*These authors have contributed equally to this work
Hai-Qiang Mai, e-mail: firstname.lastname@example.org
Keywords: nasopharyngeal carcinoma, induction chemotherapy, concurrent chemotherapy, IMRT, EBV DNA
Received: November 22, 2015 Accepted: March 28, 2016 Published: April 18, 2016
Background: The effects of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in high-risk (stage III-IVb with EBV DNA≥4000 copies/ml) nasopharyngeal carcinoma (NPC) patients are unclear.
Methods: A total of 325 high-risk NPC patients treated with IC+CCRT or CCRT alone who were treated with intensity-modulated radiation therapy (IMRT) between March 2007 and March 2013 were included. For each patient in the IC+CCRT group, a matched pair in the CCRT group was matching for: gender, age, T stage, N stage, clinical stage and WHO (World Health Organization) type. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS).
Results: There were no significant differences in OS, PFS, DMFS, and LRFS between the IC+CCRT (148 patients) and CCRT (177 patients) groups. After matching, 103 paired patients were analyzed, and there were no differences between the IC+CCRT and CCRT groups regarding clinical outcomes. Based on the subgroup analysis of 156 very-high-risk patients (stage N2-3 with EBV DNA ≥4000 copies/ml), the 5-year OS of the IC+CCRT and CCRT groups was 84.3% and 67.5% (P =0.033), respectively. Based on our multivariate analysis, the treatment group was significantly associated with OS (P=0.034; HR0.451, 95%CI 0.216-0.941).
Conclusions: IC+CCRT did not improve the clinical outcomes of high-risk NPC patients compared to CCRT alone. However, in very-high-risk patients, IC+CCRT treatment led to increased OS compared to patients received CCRT treatment alone.
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