Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China; Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, China.
Department of Radiation Oncology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
Radiother Oncol. 2023 Jul;184:109699. doi: 10.1016/j.radonc.2023.109699. Epub 2023 May 9.
To compare the acute toxicity of two different induction chemotherapy (IndCT) regimen followed by the same IMRT in patients with advanced nasopharyngeal carcinoma (NPC).
From July 2015 to December 2016, 110 NPC patients with stage III-IV diseases were prospectively randomized to receive either a conventional triweekly cisplatin + 5-fluorouracil (PF) for 3 cycles or weekly P-F for 10 doses, followed by the same IMRT to both arms. The primary endpoints of this study were grade 3/4 and any grade acute toxicities during IndCT period. The secondary endpoints included tumor response and various survivals.
Baseline patient characteristics were comparable in both groups. Patients who received weekly P-F experienced significant reduction of grade 3/4 acute toxicities, including neutropenia (12.7% vs. 40.0%, P = 0.0012), anorexia (0% vs. 14.6%, P = 0.0059), mucositis (0% vs. 14.6%, P = 0.0059), and hyponatremia (0% vs. 16.4%, P = 0.0027), compared with the triweekly PF group, resulting in fewer IndCT interruptions (1.8% vs. 16.4%, P = 0.0203), emergency room visits (0% vs. 12.7%, P = 0.0128), and additional hospitalizations (0% vs. 9.1%, P = 0.0568). The acute toxicities during IMRT period were similar. Weekly P-F arm had higher complete response rates (83.6% vs. 61.8%, P = 0.0152) and lower relapse rates (16.4% vs. 33.3%, P = 0.0402) after a median follow-up of 67 months. Kaplan-Meier survival analyses revealed a better trend of locoregional failure-free (P = 0.0892), distant metastasis failure-free (P = 0.0775), and progression-free (P = 0.0709) survivals, favoring the weekly P-F arm.
IndCT of weekly schedule does reduce acute toxicities without compromised tumor response and survivals.
比较两种不同诱导化疗（IndCT）方案联合相同调强放疗（IMRT）在晚期鼻咽癌（NPC）患者中的急性毒性。
2015 年 7 月至 2016 年 12 月，前瞻性随机分配 110 例 III-IV 期 NPC 患者分别接受常规三星期顺铂+5-氟尿嘧啶（PF）3 周期或每周 P-F 10 剂量，然后接受相同的 IMRT。本研究的主要终点为 IndCT 期间 3/4 级和任何级别急性毒性。次要终点包括肿瘤反应和各种生存。
两组患者的基线特征无差异。接受每周 P-F 的患者发生 3/4 级急性毒性显著减少，包括中性粒细胞减少（12.7% vs. 40.0%，P=0.0012）、厌食（0% vs. 14.6%，P=0.0059）、黏膜炎（0% vs. 14.6%，P=0.0059）和低钠血症（0% vs. 16.4%，P=0.0027），与三星期 PF 组相比，导致 IndCT 中断减少（1.8% vs. 16.4%，P=0.0203），急诊就诊减少（0% vs. 12.7%，P=0.0128）和额外住院治疗减少（0% vs. 9.1%，P=0.0568）。IMRT 期间的急性毒性相似。中位随访 67 个月后，每周 P-F 组完全缓解率更高（83.6% vs. 61.8%，P=0.0152），复发率更低（16.4% vs. 33.3%，P=0.0402）。Kaplan-Meier 生存分析显示局部区域无失败（P=0.0892）、远处转移无失败（P=0.0775）和无进展（P=0.0709）生存的趋势更好，每周 P-F 组更有利。
每周方案的 IndCT 可降低急性毒性而不影响肿瘤反应和生存。
