Liu Tongxin, Sun Quanquan, Chen Jing, Li Bin, Qin Weifeng, Wang Fangzheng, Ye Zhimin, Hu Fujun
Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.
Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.
J Cancer. 2018 Sep 8;9(20):3676-3682. doi: 10.7150/jca.27198. eCollection 2018.
The present study aimed to evaluate the efficacy, toxicity and long-term outcome of nedaplatin or cisplatin combined with 5-fluorouracil neoadjuvant chemotherapy (NF or PF regimen) followed by concurrent chemoradiotherapy (CCRT) for treatment of locally advanced nasopharyngeal carcinoma (NPC). In this study, a total of 186 patients with locally advanced NPC between January 2009 and November 2011 in our center were retrospectively analyzed. 103 cases were received NF neoadjuvant chemotherapy followed by nedaplatin concurrent intensity-modulated radiotherapy (IMRT), and 83 cases were received PF neoadjuvant chemotherapy followed by cisplatin concurrent IMRT. Overall survival (OS), progression-free survival (PFS) local relapse-free survival (LRFS), regional relapse-free survival (RRFS) and distant metastasis-free survival (DMFS), as well as acute toxicities were monitored. Results showed that there were no significant differences in 5-year OS, PFS, LRFS, RRFS and DMFS between NF and PF groups. NF group had a higher incidence of grade 3-4 neutropenia (46.6% vs. 31.3%, =0.035) and thrombocytopenia (17.5% vs. 7.3%, =0.042) compared with PF group. However, NF group was less common to suffer from grade 3-4 nausea (1.9% vs. 24.1%, <0.001), vomiting (0% vs. 13.3%, <0.001) and weight loss (0% vs. 4.8%, =0.025). In multivariate analysis, N stage was an independent factor for OS, PFS, RRFS and DMFS. In conclusion, neoadjuvant chemotherapy with fluorouracil plus nedaplatin followed by nedaplatin concurrent with IMRT exhibited similar efficacy but more tolerable toxicity than cisplatin setting, which might be an effective and safe choice for treatment of locally advanced NPC.
本研究旨在评估奈达铂或顺铂联合5-氟尿嘧啶新辅助化疗（NF或PF方案）后序贯同步放化疗（CCRT）治疗局部晚期鼻咽癌（NPC）的疗效、毒性及长期预后。本研究回顾性分析了2009年1月至2011年11月期间在本中心接受治疗的186例局部晚期NPC患者。103例患者接受NF新辅助化疗后行奈达铂同步调强放疗（IMRT），83例患者接受PF新辅助化疗后行顺铂同步IMRT。监测总生存期（OS）、无进展生存期（PFS）、局部无复发生存期（LRFS）、区域无复发生存期（RRFS）、远处转移无复发生存期（DMFS）以及急性毒性反应。结果显示，NF组和PF组在5年OS、PFS、LRFS、RRFS和DMFS方面无显著差异。与PF组相比，NF组3-4级中性粒细胞减少症（46.6%对31.3%，P=0.035）和血小板减少症（17.5%对7.3%，P=0.042）的发生率更高。然而，NF组3-4级恶心（1.9%对24.1%，P<0.001）、呕吐（0%对13.3%，P<0.001）和体重减轻（0%对4.8%，P=0.025）的发生率较低。多因素分析显示，N分期是OS、PFS、RRFS和DMFS的独立影响因素。综上所述，氟尿嘧啶联合奈达铂新辅助化疗后行奈达铂同步IMRT与顺铂方案疗效相似，但毒性更易耐受，可能是治疗局部晚期NPC的一种有效且安全的选择。
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