Zhang Bin, Hu Ying, Xiong Rui-Hua, Pan Yu-Fei, Xu Qian-Lan, Kong Xiang-Yun, Cai Rui, Chen Qiu-Qiu, Tang Hua-Ying, Jiang Wei
Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, PR China.
Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, PR China.
Oncotarget. 2017 Feb 21;8(8):14078-14088. doi: 10.18632/oncotarget.13285.
The relative efficacy of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) versus IC followed by radiotherapy (RT) alone in locoregionally advanced NPC remains unclear.
A total of 877 patients with locally advanced NPC who underwent IC/CCRT or IC/RT at four institutions in China between January 2004 and December 2010 were retrospectively assessed. IC was cisplatin-based combination chemotherapy; concurrent chemotherapy, single agent cisplatin. Two-dimensional conventional radiotherapy (2DCRT) was the radiotherapy technique. All patients were matched in an equal ratio using a pair-matched method. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRRFS) and toxicities were assessed.
Eligible patients were matched (n = 642; 321 patients per arm) based on eight clinicopathological characteristics. Five-year OS, DFS, DMFS, and LRRFS were 76%, 70%, 86%, and 88% for IC/CCRT and 75%, 70%, 90%, and 91% for IC/RT, respectively. There were no statistically significant survival differences between arms (P>0.05), even in subgroup analysis. In multivariate analysis, treatment (IC/CCRT vs. IC/RT) was not an independent prognostic factor for any survival end-point. Grade 3/4 acute gastrointestinal toxicities (vomiting, nausea) and hematological toxicities (leucopenia/neutropenia, thrombocytopenia and anemia) were significantly more common in the IC/CCRT arm than IC/RT arm during RT.
Overall, IC/CCRT failed to demonstrate any survival advantage but higher acute toxicities over IC/RT in locoregionally advanced NPC.
对于局部区域晚期鼻咽癌，诱导化疗（IC）后序贯同步放化疗（CCRT）与IC后序贯单纯放疗（RT）相比，其相对疗效仍不明确。
回顾性评估了2004年1月至2010年12月期间在中国四家机构接受IC/CCRT或IC/RT治疗的877例局部晚期鼻咽癌患者。IC为以顺铂为基础的联合化疗；同步化疗为单药顺铂。二维传统放疗（2DCRT）为放疗技术。所有患者采用配对匹配法按相等比例进行匹配。评估总生存期（OS）、无病生存期（DFS）、无远处转移生存期（DMFS）、局部区域无复发生存期（LRRFS）和毒性。
根据八项临床病理特征对符合条件的患者进行匹配（n = 642；每组321例患者）。IC/CCRT组的五年OS、DFS、DMFS和LRRFS分别为76%、70%、86%和88%，IC/RT组分别为75%、70%、90%和91%。两组之间的生存差异无统计学意义（P>0.05），即使在亚组分析中也是如此。在多变量分析中，治疗方式（IC/CCRT与IC/RT）不是任何生存终点的独立预后因素。在放疗期间，IC/CCRT组3/4级急性胃肠道毒性（呕吐、恶心）和血液学毒性（白细胞减少/中性粒细胞减少、血小板减少和贫血）明显比IC/RT组更常见。
总体而言，在局部区域晚期鼻咽癌中，IC/CCRT未能显示出任何生存优势，但与IC/RT相比急性毒性更高。
