Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Zhejiang, Hangzhou, 310022, People's Republic of China.
Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang, Hangzhou, 310022, People's Republic of China.
Sci Rep. 2020 Feb 12;10(1):2489. doi: 10.1038/s41598-020-59470-w.
Neoadjuvant chemotherapy (NAC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) will be the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) patients. However, many patients fail to receive CC for multiple reasons. We aimed to investigate long-term survival outcomes and toxicities in these patients with NPC treated with additional NAC plus concurrent chemoradiotherapy (CCRT) or IMRT alone. In total, 1,378 previously untreated, newly diagnosed locoregionally advanced NPC patients receiving NAC plus IMRT with or without CC were retrospectively reviewed. We used a propensity score-matched (PSM) method with 1:1 matching to identify paired patients according to various covariates. Survival outcomes and toxicities were compared between the two groups. In total, 288 pairs were identified. With a median follow-up of 86 (range: 8-110) months, the estimated 5-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival rates in patients treated with NAC plus CCRT vs. NAC plus IMRT alone were 96.1% vs. 94.7% (P = 0.201), 93.7% vs. 89.8% (P = 0.129), 91.3% vs. 85.1% (P = 0.024), and 93.0% vs. 90.6% (P = 0.362), respectively. Multivariate analysis showed that CC omission was a prognostic factor for worse PFS. In a subgroup analysis, PFS did not differ significantly between two groups of female patients or aged <60 years or stage T1-2 or stage N0-1 disease. However, fewer acute complications were observed in the NAC plus IMRT alone group. NAC with IMRT alone confers similar survival rates and less acute toxicities. Specifically, NAC plus IMRT alone may be enough for female patients <60 years with stage T1-2 or stage N0-1. However, a prospective randomised trial is needed to validate these results.
新辅助化疗（NAC）联合强度调制放疗（IMRT）加同期化疗（CC）将成为局部晚期鼻咽癌（NPC）患者的新标准治疗方法。然而，由于多种原因，许多患者无法接受 CC。我们旨在研究这些接受额外 NAC 加同期放化疗（CCRT）或单纯 IMRT 治疗的 NPC 患者的长期生存结果和毒性。
共回顾性分析了 1378 例未经治疗、新诊断为局部晚期 NPC 的患者，他们接受了 NAC 联合 IMRT 加或不加 CC。我们使用倾向评分匹配（PSM）方法，以 1:1 匹配，根据各种协变量识别配对患者。比较两组患者的生存结果和毒性。共确定了 288 对。中位随访 86 个月（范围：8-110 个月），接受 NAC 加 CCRT 与 NAC 加单纯 IMRT 治疗的患者的 5 年局部无复发生存率、远处无转移生存率、无进展生存率（PFS）和总生存率分别为 96.1%比 94.7%（P=0.201）、93.7%比 89.8%（P=0.129）、91.3%比 85.1%（P=0.024）和 93.0%比 90.6%（P=0.362）。多变量分析显示，CC 遗漏是 PFS 预后不良的因素。在亚组分析中，两组女性患者或年龄<60 岁或 T1-2 期或 N0-1 期疾病患者的 PFS 无显著差异。然而，NAC 加单纯 IMRT 组观察到的急性并发症较少。NAC 加单纯 IMRT 可获得相似的生存率和较少的急性毒性。具体来说，NAC 加单纯 IMRT 可能足以治疗年龄<60 岁、T1-2 期或 N0-1 期的女性患者。然而，需要前瞻性随机试验来验证这些结果。
