Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Shenzhen, 518116, Guangdong, P. R. China.
Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China.
Cancer Commun (Lond). 2019 Jun 27;39(1):40. doi: 10.1186/s40880-019-0380-x.
Promising efficacy and manageable toxicity of docetaxel-based concurrent chemoradiotherapy (CCRT) were reported in head and neck cancer. In addition, the effect of CCRT in combination with cisplatin and/or 5-fluorouracil on both locoregionally advanced and metastatic/recurrent nasopharyngeal carcinoma (NPC) was verified. However, CCRT with docetaxel for locoregionally advanced NPC are not well studied. This study aimed to compare effectiveness and toxicities of CCRT with weekly docetaxel versus tri-weekly cisplatin for locoregionally advanced NPC.
Clinical data of patients with locoregionally advanced NPC newly diagnosed between January 2010 and December 2014 receiving CCRT with either weekly docetaxel (15 mg/m) or tri-weekly cisplatin (80-100 mg/m) were reviewed. Propensity score matching at a 1:1 ratio was performed to balance baseline characteristics. Adverse events and survival were compared between the two groups.
A total of 962 patients were included as the whole cohort, and 448 patients were matched and were regarded as the matched cohort. The median follow-up duration was 48 months for the whole cohort. The 3-year nodal recurrence-free survival rate was significantly increased for patients treated with docetaxel in both the whole (hazard ratio [HR] = 0.37, 95% confidence interval [CI] 0.19-0.72, P = 0.030) and matched cohorts (HR = 0.33, 95% CI 0.14-0.79, P = 0.023). However, no significant differences were observed in overall survival, local recurrence-free survival, and distant metastasis-free survival between the two groups in both cohorts. Significantly higher rates of grade 3 radiodermatitis (6.7% vs. 1.8%, P = 0.001), mucositis (74.5% vs. 37.9%, P < 0.001), and leucopenia (2.2% vs. 11.6%, P < 0.001) were observed in the docetaxel group, but any grade of renal injury (1.8% vs. 15.1%, P < 0.001), vomiting (18.8% vs. 88.3%, P < 0.001), and ALT elevation (19.2% vs. 31.3%, P = 0.027) were more common in the cisplatin group.
CCRT with weekly low-dose docetaxel is an effective and tolerable therapeutic regimen for locally advanced NPC. It provides a survival benefit mainly by improving the control of regional lymph node metastases, especially for patients with low pretreatment EBV DNA levels.
基于多西他赛的同期放化疗（CCRT）在头颈部癌症中显示出有前景的疗效和可管理的毒性。此外，CCRT 联合顺铂和/或 5-氟尿嘧啶对局部晚期和转移性/复发性鼻咽癌（NPC）的疗效已得到验证。然而，局部晚期 NPC 的 CCRT 联合多西他赛的研究并不充分。本研究旨在比较局部晚期 NPC 患者接受每周多西他赛与每三周顺铂的 CCRT 的有效性和毒性。
回顾了 2010 年 1 月至 2014 年 12 月期间新诊断为局部晚期 NPC 并接受 CCRT 治疗的患者的临床数据，其中使用每周多西他赛（15mg/m）或每三周顺铂（80-100mg/m）。采用 1:1 比例的倾向评分匹配来平衡基线特征。比较两组间的不良事件和生存情况。
共纳入 962 例患者作为全队列，448 例患者进行匹配，作为匹配队列。全队列的中位随访时间为 48 个月。多西他赛组患者的 3 年淋巴结无复发生存率显著提高（风险比[HR] = 0.37，95%置信区间[CI] 0.19-0.72，P = 0.030），在匹配队列中也观察到同样的结果（HR = 0.33，95% CI 0.14-0.79，P = 0.023）。然而，两组患者的总生存、局部无复发生存和远处无转移生存无显著差异。多西他赛组患者的 3 级放射性皮炎（6.7% vs. 1.8%，P = 0.001）、粘膜炎（74.5% vs. 37.9%，P < 0.001）和白细胞减少症（2.2% vs. 11.6%，P < 0.001）发生率显著升高，但顺铂组患者的任何级别肾损伤（1.8% vs. 15.1%，P < 0.001）、呕吐（18.8% vs. 88.3%，P < 0.001）和丙氨酸氨基转移酶升高（19.2% vs. 31.3%，P = 0.027）发生率更高。
每周低剂量多西他赛的 CCRT 是局部晚期 NPC 的一种有效且可耐受的治疗方案。它主要通过改善区域淋巴结转移的控制来提供生存获益，特别是对于治疗前 EBV DNA 水平较低的患者。
