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Strahlentherapie und Onkologie

, Volume 192, Issue 6, pp 394–402 | Cite as

Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

A matched-pair multicenter analysis of outcomes
  • Yi-Yuan Dong
  • Chun Xiang
  • Jian-Xun Lu
  • Yi-Xin Su
  • Yu-Fei Pan
  • Rui Cai
  • Rong-Jun Zhang
  • Zhuo-Kai He
  • Mei-Lian Liu
  • Hui Huang
  • Xue Bai
  • Hua-Ying Tang
  • Yun-Hua Shi
  • Yan Wang
  • Wei JiangEmail author
Original Article

Abstract

Purpose

The benefit of adjuvant chemotherapy (AC) in locoregionally advanced nasopharyngeal carcinoma (NPC) is controversial. This study compared concurrent chemoradiotherapy plus AC (CCRT/AC) with CCRT.

Methods

Pair-matched analysis based on eight clinicopathological features of 244 patients treated with platinum-based CCRT/AC or CCRT alone was performed. Survival outcomes were assessed using the Kaplan–Meier method and log-rank test. Toxicities and response rates were compared using Fisher’s exact test.

Results

Four-year overall survival, progression-free survival, distant failure-free survival, and locoregional failure-free survival were 72 %, 61 %, 71 %, and 81 %, respectively, for the CCRT arm, compared to 74 % (hazard ratio, HR 0.89; 95 % confidence interval, CI 0.64–1.23; P = 0.474), 62 % (HR 0.91, 95 % CI 0.68–1.20, P = 0.489), 73 % (HR 0.84, 95 % CI 0.59–1.18, P = 0.316), and 84 % (HR 0.84, 95 % CI 0.52–1.24, P = 0.323), respectively, for the CCRT/AC arm. Cox multivariate regression analysis demonstrated AC was not an independent prognostic factor. Overall, there was a higher incidence of grade 3–4 toxicities in the CCRT/AC arm. The most common grade 3–4 adverse events in the CCRT/AC arm were vomiting (27 %), nausea (43 %), leukopenia/neutropenia (23 %), thrombocytopenia (8.8 %), and anemia (6.2 %).

Conclusion

Addition of AC to CCRT increased toxicities but did not improve survival in locoregionally advanced NPC.

Keywords

Survival Adverse events Toxicity Radiation oncology China 

Simultane Radiochemotherapie plus adjuvante Chemotherapie versus alleinige simultane Radiochemotherapie beim lokal fortgeschrittenen Nasopharynxkarzinom

Eine multizentrische „Matched-pair“-Analyse zum Outcome

Zusammenfassung

Zielsetzung

Der Nutzen der adjuvanten Chemotherapie (AC) bei lokoregional fortgeschrittenem nasopharyngealem Karzinom (NPC) ist kontrovers. In dieser Studie wurde die simultane Radiochemotherapie („concurrent chemoradiotherapy“, CCRT) plus adjuvante Chemotherapie (AC) mit einer alleinigen CCRT verglichen.

Patienten und Methoden

Die Matched-pair-Analyse basiert auf acht klinisch-pathologischen Merkmalen von 244 Patienten, die mit platinbasierter CCRT/AC oder alleiniger CCRT behandelt wurden. Die Überlebensendpunkte wurden mit der Kaplan-Meier-Methode und dem Log-Rang-Test beurteilt. Toxische Reaktionen und Ansprechraten wurden mit dem exakten Fisher-Test verglichen.

Ergebnisse

Das Vier-Jahres-Gesamtüberleben, das progressionsfreie Überleben, das fernmetastasenfreie Überleben ohne Therapieversagen und das lokoregionale Überleben ohne Therapieversagen betrugen jeweils 72 %, 61 %, 71 % bzw. 81 % im CCRT-Arm im Vergleich mit 74 % (Hazard-Ratio [HR] 0,89; 95 %-Konfidenzintervall [KI] 0,64–1,23; p = 0,474), 62 % (HR 0,91; 95 %-KI 0,68–1,20; p = 0,489), 73 % (HR 0,84; 95 %-KI 0,59–1,18; p = 0,316) und 84 % (HR 0,84; 95 %-KI 0,52–1,24; p = 0,323) im CCRT/AC-Arm. Die multivariate Cox-Regressionsanalyse zeigte, dass AC kein unabhängiger Prognosefaktor war. Insgesamt lag im CCRT/AC-Arm eine höhere Inzidenz von toxischen Reaktionen vom Grad 3–4 vor. Die häufigsten unerwünschten Ereignisse vom Grad 3–4 im CCRT/AC-Arm waren Erbrechen (27 %), Übelkeit (43 %), Leukopenie/Neutropenie (23 %), Thrombozytopenie (8,8 %) und Anämie (6,2 %).

Schlussfolgerung

Eine zusätzliche AC zur CCRT erhöhte die toxischen Reaktionen, führte jedoch zu keiner Verbesserung des Überlebens bei lokal fortgeschrittenem NPC.

Schlüsselwörter

Überleben Nebenwirkungen Toxizität Strahlenonkologie China 

Notes

Acknowledgements

This work was supported by grants from the Scientific Research and Technology Development Program of Guilin (No. 20110119-1-3), the National Natural Science Foundation of China (No. 81560443), the Guangxi National Natural Science Foundation (No. 2013GXNSFBA019155), the Guangxi Medical Scientific Experiment Center Open Fund (GK2014-TKF04), and the Scientific Research and Technology Development Program of Qinzhou (No. 20136115).

Compliance with ethical guidelines

Conflict of interest

Y.-Y. Dong, C. Xiang, J.-X. Lu, Y.-X. Su, Y.-F. Pan, R. Cai, R.-J. Zhang, Z.-K. He, M.-L. Liu, H. Huang, X. Bai, H.-Y. Tang, Y.-H. Shi, Y. Wang, and W. Jiang state that there are no conflicts of interest.

Ethical standards

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yi-Yuan Dong
    • 1
    • 6
  • Chun Xiang
    • 2
  • Jian-Xun Lu
    • 3
  • Yi-Xin Su
    • 4
  • Yu-Fei Pan
    • 5
  • Rui Cai
    • 1
  • Rong-Jun Zhang
    • 1
  • Zhuo-Kai He
    • 1
  • Mei-Lian Liu
    • 1
  • Hui Huang
    • 1
  • Xue Bai
    • 1
  • Hua-Ying Tang
    • 1
  • Yun-Hua Shi
    • 1
  • Yan Wang
    • 1
  • Wei Jiang
    • 1
    Email author
  1. 1.Department of Radiation OncologyAffiliated Hospital of Guilin Medical UniversityGuilinPR China
  2. 2.Department of OtorhinolaryngologyNan Xishan HospitalGuilinPR China
  3. 3.Department of OncologyAffiliated Hospital of Youjiang Medical University for NationalitiesBaisePR China
  4. 4.Department of Radiation OncologyLingshan People’s HospitalLingshanPR China
  5. 5.Department of Radiation OncologyNan Xishan HospitalGuilinPR China
  6. 6.Department of OtorhinolaryngologyGuilin Medical University Affiliated HospitalGuilinPR China

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