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J Cancer. 2018 Apr 30;9(11):2030-2037. doi: 10.7150/jca.25042. eCollection 2018.

Addition of chemotherapy to intensity-modulated radiotherapy does not improve survival in stage II nasopharyngeal carcinoma patients.

Author information

1
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.
2
Key Laboratory of Radiation Oncology of Zhejiang Province, Zhejiang Hangzhou, 310022, People's Republic of, China.
3
Department of Breast Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.
4
Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.
5
Department of Radiology, Fukui Red Cross Hospital, Fukui Japan.
6
Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.
7
Department of Ultrasonography, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of, China.
8
Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing, 100101, People's Republic of, China.

Abstract

In this study, we examined whether combining neoadjuvant chemotherapy (NAC) and/or concurrent chemotherapy (CC) with intensity-modulated radiotherapy (IMRT) improved survival in patients with stage II nasopharyngeal carcinoma (NPC). Two hundred forty-two stage II NPC patients were enrolled between May 2008 and April 2014 and received radical IMRT with simultaneous integrated boost technique using 6 MV photons; some patient groups also received chemotherapy every 3 weeks for 2-3 cycles. The median follow-up duration was 69 months for all patients. At the last follow-up, 18 patients had experienced treatment failure; locoregional relapse among the IMRT alone, NAC+IMRT, NAC+CCRT, and CCRT occurred in 3, 3, 4 and 5, respectively; distant metastases in 0, 0, 2 and 1, respectively, and there was a statistically significant difference among four groups (P=0.019). The 5-year locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates for all patients were 94.7%, 98.7%, 92.9%, and 93.4%, respectively. Five-year LRRFS, DMFS, PFS, and OS were similar among the IMRT alone, NAC+IMRT, NAC+CCRT, and CCRT treatment groups. Univariate and multivariate analyses revealed that a combined regimen was not an independent prognostic factor for any survival outcome. However, patients who received IMRT plus chemotherapy experienced more acute adverse events than those who received IMRT alone. Thus, the addition of NAC and/or CC to IMRT did not improve survival outcomes, but was associated with higher incidences of acute treatment-associated toxicities than IMRT alone in patients with stage II NPC.

KEYWORDS:

concurrent chemoradiotherapy; intensity-modulated radiotherapy; neoadjuvant chemotherapy; prognosis; stage II nasopharyngeal carcinoma; toxicity

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

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