Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Nursing, Hung Kuang University, Taichung, Taiwan.
Sci Rep. 2018 Jan 11;8(1):470. doi: 10.1038/s41598-017-18713-z.
Concurrent chemoradiotherapy (CCRT) is the current standard of care for advanced nasopharyngeal carcinoma (NPC). We hypothesize that shifting CCRT to neoadjuvant chemotherapy followed by radiotherapy (NeoCT-RT) is an alternative option. From December 2004 to January 2009, 256 NPC patients with stage II-IVB were treated by either CCRT or NeoCT-RT. All patients received the same dosage and fractionation schedule of RT. After long-term follow-up, 26.8% (34/127) and 23.3% (30/129) of patients who received CCRT and NeoCT-RT respectively, developed a tumor relapse (P = 0.6134). Overall survival (HR = 1.52, 95%CI = 0.91-2.55, P = 0.1532) and progression-free survival (HR = 1.22, 95%CI = 0.75-1.99, P = 0.4215) were similar in both groups. However, acute toxicities during RT period revealed a significant reduction of grade 3/4 vomiting (23% vs. 0%, P < 0.0001), mucositis (55% vs. 16%, P < 0.0001), and neck dermatitis (31% vs. 16%, P = 0.0041) in the NeoCT-RT group, resulting in fewer emergency room visits (10.2% vs. 1.6%, P = 0.0071). Severe treatment-related late toxicity (15% vs. 14%, P = 0.9590) and the occurrence of second malignancy (3.9% vs. 5.4%, P = 0.7887) also showed no differences. We concluded that NeoCT-RT could be an attractive alternative option of CCRT for advanced NPC.
同期放化疗（CCRT）是目前治疗晚期鼻咽癌（NPC）的标准治疗方法。我们假设将 CCRT 改为新辅助化疗后放疗（NeoCT-RT）是一种替代选择。从 2004 年 12 月至 2009 年 1 月，256 例 II-IVB 期 NPC 患者分别接受 CCRT 或 NeoCT-RT 治疗。所有患者均接受相同剂量和分割方案的放疗。经过长期随访，分别接受 CCRT 和 NeoCT-RT 的患者中有 26.8%（34/127）和 23.3%（30/129）发生肿瘤复发（P=0.6134）。两组的总生存（HR=1.52，95%CI=0.91-2.55，P=0.1532）和无进展生存（HR=1.22，95%CI=0.75-1.99，P=0.4215）相似。然而，放疗期间的急性毒性反应显示，NeoCT-RT 组的 3/4 级呕吐（23%比 0%，P<0.0001）、黏膜炎（55%比 16%，P<0.0001）和颈部皮炎（31%比 16%，P=0.0041）发生率显著降低，导致急诊就诊次数减少（10.2%比 1.6%，P=0.0071）。严重的治疗相关晚期毒性（15%比 14%，P=0.9590）和第二恶性肿瘤的发生（3.9%比 5.4%，P=0.7887）也没有差异。我们得出结论，NeoCT-RT 可能是晚期 NPC 的 CCRT 的一种有吸引力的替代选择。
