Department of Radiotherapy, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Radiotherapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Cancer Med. 2023 Jan;12(1):223-235. doi: 10.1002/cam4.4899. Epub 2022 Jun 8.
Induction chemotherapy (IC) comprising docetaxel, cisplatin, and fluorouracil (TPF), combined with concurrent chemoradiotherapy (CCRT) effectively improves the survival rate of locally advanced nasopharyngeal carcinoma (LA-NPC). Selecting patients whose risk of tumor recurrence and metastasis is high and the appropriate chemotherapy intensity is a concern. We combined tumor-node-metastasis staging with the load of Epstein-Barr virus (EBV) after IC to select the individualized chemotherapy strength.
The clinical data and prognostic factors of patients with stage III-IV LA-NPC treated with TPF IC combined with CCRT were analyzed retrospectively. The conventional treatment group received the standard three cycles TPF IC combined with CCRT. For the new treatment group, the cycles of IC were determined according to whether the EBV-DNA disappeared completely after a certain course of IC, if so, subsequent IC was stopped and the chemoradiotherapy stage was entered. Propensity score matching (PSM) was performed at a ratio of 1:1 to balance baseline characteristics. Survival outcomes and adverse events between the conventional treatment group and the new method treatment group were compared.
The study included 256 patients, among whom 192 were matched successfully into 96 pairs. The patients were followed up for a median of 51 months. The proportions of patients receiving three, two, and one cycle of IC after PSM in the routine and new treatment cohorts were 93.8%, 3.1%, 3.1% versus 21.9%, 49.0%, 24.0%, respectively. However, their 3-year distant metastasis-free survival, local recurrence-free survival, progression-free survival, and overall survival did not differ significantly. The incidence of grade 3-4 neutropenia toxicity in CCRT decreased significantly in patients receiving the new treatment method compared with that in the conventional treatment group (p = 0.026).
Combining TNM stage and EBV-DNA load after IC to determine the courses of IC in patients with LA-NPC did not alter the curative effect but decreased toxicity.
包含多西他赛、顺铂和氟尿嘧啶（TPF）的诱导化疗（IC）联合同期放化疗（CCRT）可有效提高局部晚期鼻咽癌（LA-NPC）患者的生存率。选择肿瘤复发和转移风险高以及适当化疗强度的患者是一个关注点。我们将肿瘤-淋巴结-转移分期与 IC 后的 EBV 负荷相结合，以选择个体化的化疗强度。
回顾性分析了接受 TPF IC 联合 CCRT 治疗的 III-IV 期 LA-NPC 患者的临床数据和预后因素。常规治疗组接受标准的三个周期 TPF IC 联合 CCRT。对于新治疗组，根据 IC 一定疗程后 EBV-DNA 是否完全消失来确定 IC 的周期，如果是，则停止后续 IC 并进入放化疗阶段。采用 1:1 的倾向评分匹配（PSM）来平衡基线特征。比较常规治疗组和新方法治疗组的生存结果和不良事件。
研究共纳入 256 例患者，其中 192 例经 PSM 成功匹配为 96 对。中位随访 51 个月。PSM 后常规和新治疗组患者接受三个、两个和一个 IC 周期的比例分别为 93.8%、3.1%、3.1%和 21.9%、49.0%、24.0%。然而，两组患者的 3 年远处无转移生存率、局部无复发生存率、无进展生存率和总生存率无显著差异。与常规治疗组相比，接受新治疗方法的患者在 CCRT 中 3-4 级中性粒细胞毒性的发生率显著降低（p=0.026）。
在 LA-NPC 患者中，将 IC 后的 TNM 分期和 EBV-DNA 载量相结合来确定 IC 的疗程并不会改变疗效，但可降低毒性。
