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Oncotarget. 2016 May 17;7(20):29739-48. doi: 10.18632/oncotarget.8828.

Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in stage III-IVb nasopharyngeal carcinoma patients with Epstein-Barr virus DNA ≥4000 copies/ml: a matched study.

Guo SS1,2, Tang LQ1,2, Chen QY1,2, Zhang L1,2, Liu LT1,2, Guo L1,2, Mo HY1,2, Luo DH1,2, Huang PY1,2, Xiang YQ1,2, Sun R1,2, Chen MY1,2, Wang L1,2, Lv X1,2, Zhao C1,2, Guo X1,2, Cao KJ1,2, Qian CN1,2, Zeng MS1, Bei JX1, Hong MH1,3, Shao JY1,4, Sun Y1,5, Ma J1,5, Mai HQ1,2.

Author information

1
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
2
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
3
Good Clinical Practice Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
4
Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
5
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.

Abstract

BACKGROUND:

The effects of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in high-risk (stage III-IVb with EBV DNA≥4000 copies/ml) nasopharyngeal carcinoma (NPC) patients are unclear.

METHODS:

A total of 325 high-risk NPC patients treated with IC+CCRT or CCRT alone who were treated with intensity-modulated radiation therapy (IMRT) between March 2007 and March 2013 were included. For each patient in the IC+CCRT group, a matched pair in the CCRT group was matching for: gender, age, T stage, N stage, clinical stage and WHO (World Health Organization) type. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS).

RESULTS:

There were no significant differences in OS, PFS, DMFS, and LRFS between the IC+CCRT (148 patients) and CCRT (177 patients) groups. After matching, 103 paired patients were analyzed, and there were no differences between the IC+CCRT and CCRT groups regarding clinical outcomes. Based on the subgroup analysis of 156 very-high-risk patients (stage N2-3 with EBV DNA ≥4000 copies/ml), the 5-year OS of the IC+CCRT and CCRT groups was 84.3% and 67.5% (P =0.033), respectively. Based on our multivariate analysis, the treatment group was significantly associated with OS (P=0.034; HR0.451, 95%CI 0.216-0.941).

CONCLUSIONS:

IC+CCRT did not improve the clinical outcomes of high-risk NPC patients compared to CCRT alone. However, in very-high-risk patients, IC+CCRT treatment led to increased OS compared to patients received CCRT treatment alone.

KEYWORDS:

EBV DNA; IMRT; concurrent chemotherapy; induction chemotherapy; nasopharyngeal carcinoma

PMID:
27105538
PMCID:
PMC5045429
DOI:
10.18632/oncotarget.8828
[Indexed for MEDLINE]
Free PMC Article

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