Hubei Key Laboratory of Tumor Biological Behaviors, Department of Radiation and Medical Oncology, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
Eur Arch Otorhinolaryngol. 2023 Apr;280(4):1999-2006. doi: 10.1007/s00405-022-07794-w. Epub 2023 Jan 11.
Induction chemotherapy (IC) followed by concurrent chemo-radiotherapy (CCRT) is the current standard of care for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) patients. However, there is still no consensus on the optimum number of IC cycles. In this study, we aimed to assess the efficacy and toxicities of two or more cycles of IC for LA-NPC patients.
Data of LA-NPC patients consecutively treated with IC followed by concurrent chemo-radiotherapy (CCRT) in our institute from 2017 to 2022 were retrospectively retrieved and analyzed. Survival outcomes of patients who received two IC cycles were compared with those who received more than two IC cycles. Univariate and multivariate Cox regression analysis were then performed to determine factors that could be independent predictors of survival. Chi-square test and Fisher's exact test were used to compare treatment associated acute toxicities between the two groups.
A total of 125 patients were recruited in this study. There were 89 patients who received 2 cycles (IC = 2) of IC and 36 received more than 2 cycles (IC > 2) of IC. The median follow-up time was 26 months [IQR 16-38]. The 3-year overall survival rate was not statistically significant between the two groups (95.50% vs. 86.11%, P = 0.501). Similarly, loco-regional recurrence free survival and progression free survival were not significant (97.75% vs. 97.22%, P = 0.694; and 88.76% vs. 83.33%, P = 0.129), but distant metastasis free survival was significant (88.76% vs. 86.11%, P = 0.049). Multivariate Cox regression analysis showed that IC regimen was an independent prognostic factor.
Two cycles of IC is effective and more than two does not add any additional benefit to the survival outcomes of LA-NPC patients.
诱导化疗（IC）联合同期放化疗（CCRT）是局部晚期鼻咽癌（LA-NPC）患者的标准治疗方法。然而，对于 IC 的最佳周期数仍没有共识。在这项研究中，我们旨在评估 LA-NPC 患者接受两个或更多周期 IC 的疗效和毒性。
回顾性收集 2017 年至 2022 年在我院接受 IC 联合同期放化疗的 LA-NPC 患者的数据，并进行分析。比较接受 2 个 IC 周期的患者和接受超过 2 个 IC 周期的患者的生存结果。然后进行单因素和多因素 Cox 回归分析，以确定可能是生存的独立预测因素。使用卡方检验和 Fisher 精确检验比较两组之间与治疗相关的急性毒性。
本研究共纳入 125 例患者。其中 89 例患者接受 2 个周期的 IC（IC=2），36 例患者接受超过 2 个周期的 IC（IC>2）。中位随访时间为 26 个月[IQR 16-38]。两组患者的 3 年总生存率无统计学差异（95.50% vs. 86.11%，P=0.501）。同样，局部区域无复发生存率和无进展生存率也无显著差异（97.75% vs. 97.22%，P=0.694；88.76% vs. 83.33%，P=0.129），但远处无转移生存率有显著差异（88.76% vs. 86.11%，P=0.049）。多因素 Cox 回归分析显示，IC 方案是独立的预后因素。
2 个周期的 IC 是有效的，超过 2 个周期不会给 LA-NPC 患者的生存结果带来额外的益处。
