Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China.
Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, PR China.
Radiother Oncol. 2024 May;194:110189. doi: 10.1016/j.radonc.2024.110189. Epub 2024 Mar 1.
Whether concurrent chemoradiotherapy would provide survival benefits in patients with stage II and T3N0 NPC with adverse factors remains unclear in IMRT era. We aimed to assess the value of concurrent chemotherapy compared to IMRT alone in stage II and T3N0 NPC with adverse features.
287 patients with stage II and T3N0 NPC with adverse factors were retrospectively analyzed, including 98 patients who received IMRT alone (IMRT alone group) and 189 patients who received cisplatin-based concurrent chemotherapy (CCRT group). The possible prognostic factors were balanced using propensity score matching (PSM). Kaplan-Meier analysis was used to evaluate the survival rates, and log-rank tests were employed to compare differences between groups.
The median follow-up duration was 90.8 months (interquartile range = 75.6-114.7 months). The IMRT alone and the CCRT group were well matched; however, for all survival-related endpoints, there were no significant differences between them (5-year failure-free survival: 84.3% vs. 82.7%, P value = 0.68; 5-year overall survival: 87.3% vs. 90.6%, P value = 0.11; 5-year distant metastasis-free survival: 92.8% vs. 92.5%, P value = 0.97; 5-year locoregional relapse-free survival: 93.4% vs. 89.9%, P value = 0.30). The incidence of acute toxicities in the IMRT alone group was significantly lower than that in the CCRT group.
For patients with stage II and T3N0 NPC with adverse features treated using IMRT, no improvement in survival was gained by adding concurrent chemotherapy; however, the occurrence of acute toxicities increased significantly. For those combined with non-single adverse factors, the comprehensive treatment strategy needs further exploration.
在调强放疗（IMRT）时代，对于具有不良因素的 II 期和 T3N0 NPC 患者，同步放化疗是否能带来生存获益尚不清楚。本研究旨在评估与单纯 IMRT 相比，同步放化疗在具有不良特征的 II 期和 T3N0 NPC 患者中的价值。
回顾性分析了 287 例具有不良因素的 II 期和 T3N0 NPC 患者，包括 98 例接受单纯 IMRT（单纯 IMRT 组）和 189 例接受顺铂为基础的同步化疗（CCRT 组）的患者。采用倾向评分匹配（PSM）平衡可能的预后因素。Kaplan-Meier 分析用于评估生存率，对数秩检验用于比较组间差异。
中位随访时间为 90.8 个月（四分位距=75.6-114.7 个月）。单纯 IMRT 组和 CCRT 组匹配良好，但在所有与生存相关的终点上，两组间无显著差异（5 年无失败生存率：84.3% vs. 82.7%，P 值=0.68；5 年总生存率：87.3% vs. 90.6%，P 值=0.11；5 年远处无转移生存率：92.8% vs. 92.5%，P 值=0.97；5 年局部区域无复发生存率：93.4% vs. 89.9%，P 值=0.30）。单纯 IMRT 组的急性毒性发生率明显低于 CCRT 组。
对于采用 IMRT 治疗的 II 期和 T3N0 NPC 伴不良特征的患者，同步化疗并未带来生存获益的提高，反而显著增加了急性毒性的发生。对于合并非单一不良因素的患者，需要进一步探索综合治疗策略。
