Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
Oncol Res Treat. 2021;44(11):602-612. doi: 10.1159/000519278. Epub 2021 Oct 1.
Nasopharyngeal carcinoma (NPC) originates from the mucous epithelium of the nasopharynx. Although induction chemotherapy plus concurrent chemoradiotherapy is the major therapeutic protocol used for locally advanced NPC without metastasis, more research studies are needed to evaluate the curative effects. We aim to identify the therapeutic effects and prognosis after induction chemotherapy plus concurrent chemoradiotherapy in the treatment of locally advanced NPC under the intensity-modulated radiotherapy mode.
The patients (N = 544) with locally advanced NPC (III and Iva, UICC 8th) after intensity-modulated radiotherapy with induction chemotherapy and concurrent chemoradiotherapy were included in this study. We analyzed the characteristics of patients including gender, age, smoking status, tumor node staging system, clinical stage, pathological type, the therapy protocol of induction chemotherapy and concurrent chemoradiotherapy, and chemotherapy prescription.
We have found the 5-year survival rates of overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were 85.21%, 78.51%, 90.71%, and 85.21% in follow-up, and these data indicated that our therapeutic procedure provided beneficial effects on survival rates. Subsequently, the chemotherapy drug based on docetaxel (DOC) provided a more beneficial effect on survival rate compared with taxol (TXT) (all estimated HR >1; p = 0.005, 0.004, and <0.001 of OS, PFS, and DMFS), but there was no significant difference between chemotherapy drugs based on cisplatin (DDP) and nedaplatin (NDP) in treating NPC patients (p = 0.390, 0.549, 0.364, and 0.645 of OS, PFS, LRRFS, and DMFS). The therapeutic effects of induction chemotherapy revealed no difference between TPF and TP (T: DOC or TXT, P: DDP or NDP, and F: 5-fluorouracil) (p = 0.541, 0.897, 0.498, and 0.765 of OS, PFS, LRRFS, and DMFS). In addition, there was also no significant change between concurrent chemotherapy with TP dual drugs or a single platinum drug (being excluded in the multivariate model using forward [Wald] procedure). Moreover, the survival rate showed no difference between platinum accumulation dose of more or less than 150 mg/m2 for concurrent chemotherapy (being excluded in the multivariate model using forward [Wald] procedure).
Our results indicate that induction chemotherapy plus concurrent chemoradiotherapy under intensity-modulated radiotherapy which is the standard therapeutic method for locally advanced NPC provides beneficial therapeutic effects, and it is worthy of further study.
鼻咽癌（NPC）起源于鼻咽部的黏膜上皮。虽然诱导化疗加同期放化疗是治疗无转移的局部晚期 NPC 的主要治疗方案，但仍需要更多的研究来评估其疗效。我们旨在确定调强放疗模式下诱导化疗加同期放化疗治疗局部晚期 NPC 的治疗效果和预后。
本研究纳入了 544 例接受诱导化疗加同期放化疗的局部晚期 NPC（UICC 8 期 III 和 IVa 期）患者。我们分析了患者的特征，包括性别、年龄、吸烟状况、肿瘤淋巴结分期系统、临床分期、病理类型、诱导化疗和同期放化疗的治疗方案以及化疗方案。
我们发现，在随访中，总生存率（OS）、无进展生存率（PFS）、局部区域无复发生存率（LRRFS）和无远处转移生存率（DMFS）的 5 年生存率分别为 85.21%、78.51%、90.71%和 85.21%，这些数据表明我们的治疗方案对生存率有有益的影响。随后，基于多西紫杉醇（DOC）的化疗药物比紫杉醇（TXT）更能提高生存率（所有估计 HR>1；p=0.005、0.004 和 <0.001 的 OS、PFS 和 DMFS），但顺铂（DDP）和奈达铂（NDP）基础上的化疗药物在治疗 NPC 患者方面没有差异（p=0.390、0.549、0.364 和 0.645 的 OS、PFS、LRRFS 和 DMFS）。诱导化疗的疗效在 TPF 和 TP 之间没有差异（T：DOC 或 TXT，P：DDP 或 NDP，F：5-氟尿嘧啶）（p=0.541、0.897、0.498 和 0.765 的 OS、PFS、LRRFS 和 DMFS）。此外，在多变量模型中使用正向（Wald）程序排除同步化疗中使用 TP 双药或单铂药物的情况下，疗效也没有差异。此外，对于同步化疗中铂累积剂量大于或小于 150mg/m2 的情况，生存率也没有差异（在多变量模型中使用正向（Wald）程序排除）。
我们的结果表明，调强放疗下的诱导化疗加同期放化疗是治疗局部晚期 NPC 的标准治疗方法，具有有益的治疗效果，值得进一步研究。
