Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Geriatrics Center, West China Hospital, Sichuan University, Chengdu, China.
Clin Otolaryngol. 2021 Sep;46(5):976-982. doi: 10.1111/coa.13763. Epub 2021 Apr 5.
The optimal treatment strategy of combining systemic chemotherapy and radiotherapy for nasopharyngeal carcinoma (NPC) is controversial. This study aimed to compare the efficacy and toxicities of induction chemotherapy followed by intensity-modulated radiotherapy (IC-RT) versus concurrent chemoradiotherapy (CCRT) in NPC.
Of 448 stage II-IVb NPC patients treated with IC-RT or CCRT were retrospectively analysed. The primary outcome was overall survival, which was analysed by using Kaplan-Meier curves and log-rank (Mantel-Cox) test.
The median follow-up was 66 months (interquartile range, 46-84 months). There was no statistically significant difference in the estimated 5-year overall survival (OS), progression-free survival (PFS), distance metastasis-free survival (DMFS) and locoregional relapse-free survival (LRFS) between IC-RT group and CCRT group (OS: 89.5% vs 91.7%, P = .568; PFS: 85.2% vs 87.5%, P = .615; DMFS: 90.9% vs 91.7%, P = .847; LRFS: 92.0% vs 96.9%, P = .104). In the multivariate analysis, the treatment group (IC-RT vs CCRT) was not an independent prognostic factor for OS, PFS, DMFS and LRFS. Less advanced tumour stage and lymph node stage were predictive of higher OS. EBV-DNA level was an independent prognostic factor that was only significantly associated with LRFS.
IC-RT achieves similar survival outcomes and treatment-related toxicities as CCRT in OS, PFS, DMFS and LRFS for patients with NPC. We need multicentre randomised controlled trials to reconfirm our data.
关于鼻咽癌（NPC）联合全身化疗和放疗的最佳治疗策略存在争议。本研究旨在比较诱导化疗后行调强放疗（IC-RT）与同期放化疗（CCRT）在 NPC 中的疗效和毒性。
回顾性分析了 448 例接受 IC-RT 或 CCRT 治疗的 II-IVb 期 NPC 患者。主要结局是总生存期，采用 Kaplan-Meier 曲线和对数秩（Mantel-Cox）检验进行分析。
中位随访时间为 66 个月（四分位距 46-84 个月）。IC-RT 组与 CCRT 组的 5 年总生存率（OS）、无进展生存率（PFS）、无远处转移生存率（DMFS）和无局部区域复发生存率（LRFS）无统计学差异（OS：89.5% vs 91.7%，P=0.568；PFS：85.2% vs 87.5%，P=0.615；DMFS：90.9% vs 91.7%，P=0.847；LRFS：92.0% vs 96.9%，P=0.104）。多因素分析显示，治疗组（IC-RT 与 CCRT）不是 OS、PFS、DMFS 和 LRFS 的独立预后因素。较晚的肿瘤分期和淋巴结分期是 OS 更高的预测因素。EBV-DNA 水平是一个独立的预后因素，仅与 LRFS 显著相关。
在 OS、PFS、DMFS 和 LRFS 方面，IC-RT 与 CCRT 相比，可达到相似的生存结果和治疗相关毒性。我们需要多中心随机对照试验来重新确认我们的数据。
