Department of Radiation Oncology, XiJing Hospital, Fourth Military Medical University, No.127, Chang Le West Road, Xi'an, 710032, China.
Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, Xi'an, China.
J Cancer Res Clin Oncol. 2020 Sep;146(9):2369-2378. doi: 10.1007/s00432-020-03229-3. Epub 2020 May 3.
Although several trials have confirmed the treatment efficacy of induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) from endemic area of China, little is known about the best regime for induction chemotherapy in non-endemic region. This study compared the treatment effect of Gemcitabine and cisplatin (GP) versus docetaxel and cisplatin (TP) followed by concurrent chemoradiotherapy in locoregionally advanced NPC from non-endemic area of China.
A total of 196 locoregionally advanced NPC patients were enrolled in this study, with 142 and 54 patients in TP and GP followed by concurrent chemoradiotherapy groups. The primary endpoint was treatment response of induction chemotherapy. The secondary endpoints included disease-free survival. The Kaplan-Meier method was used to evaluate the efficacy between treatment groups.
The median follow-up time was 45.5 months (range: 6-60.5 months). During induction chemotherapy course, GP contributed higher treatment response rate than TP (68.1% vs. 47.1%, p = 0.007). Patients in GP group had better DFS and LRFS than those in TP group (3-year and 5-year DFS, 86.8% and 82.5% vs. 71.7% and 68%, p = 0.036; 3-year and 5-year LRFS, 96.2% and 96.2% vs. 90.5% and 82.8%, p = 0.03). No significant difference of adverse events was observed between two treatment groups in the whole course.
This study suggested that GP followed by CCRT was better than TP followed by CCRT in improving survival outcomes of locoregionally advanced NPC patients from non-endemic area of China.
尽管几项试验已经证实了诱导化疗加同期放化疗（CCRT）在局部晚期鼻咽癌（NPC）中的治疗效果，但是对于非流行地区的诱导化疗最佳方案知之甚少。本研究比较了吉西他滨和顺铂（GP）与多西他赛和顺铂（TP）诱导化疗后在非流行地区局部晚期 NPC 中的治疗效果。
共纳入 196 例局部晚期 NPC 患者，其中 TP 组和 GP 组分别有 142 例和 54 例患者接受同期放化疗。主要终点是诱导化疗的治疗反应。次要终点包括无病生存。采用 Kaplan-Meier 法评估治疗组之间的疗效。
中位随访时间为 45.5 个月（范围：6-60.5 个月）。在诱导化疗过程中，GP 组的治疗反应率高于 TP 组（68.1%比 47.1%，p=0.007）。GP 组患者的无病生存和局部区域无复发生存均优于 TP 组（3 年和 5 年无病生存率分别为 86.8%和 82.5%比 71.7%和 68%，p=0.036；3 年和 5 年局部区域无复发生存率分别为 96.2%和 96.2%比 90.5%和 82.8%，p=0.03）。两组患者在整个治疗过程中的不良反应发生率无显著差异。
本研究表明，GP 联合 CCRT 可改善非流行地区局部晚期 NPC 患者的生存结局，优于 TP 联合 CCRT。
