ABSTRACT
Objective: To compare the efficacy of induction chemotherapy (IC) plus intensity-modulated radiotherapy (IMRT) with that of concurrent chemo-radiotherapy (CCRT) plus adjuvant chemotherapy (AC) for patients with loco-regionally advanced naso-pharyngeal carcinoma (NPC). Methods:Data of 240 patients with loco-regionally advanced NPC were reviewed. These patients were admitted to the Sun Yat-sen University Cancer Center between January 2004 and December 2008. Among the 240 patients, 117 under-went the IC+IMRT and 123 were treated with the CCRT+AC. The IC+IMRT group received a regimen including cisplatin and 5-fluoro-uracil (5-FU). The CCRT+AC group received cisplatin concurrently with radiotherapy and subsequently received adjuvant cisplatin and 5-FU. The survival rates of the patients were assessed by Kaplan-Meier analysis, and the survival curves were compared by Log-rank test. Multivariate analysis was conducted using Cox proportional hazard regression model. Results:The 5-year overall survival (OS), disease-free survival, distant metastasis-free survival, local relapse-free survival, and the nodal relapse-free survival were 78.0%versus 78.7%, 68.9%versus 67.5%, 79.0%versus 77.0%, 91.6%versus 91.0%, and 95.3%versus 93.7%in the IC+IMRT and CCRT+AC groups, respectively. The survival between the two groups exhibited no significant differences. Higher rates of Grades 3 to 4 nau-sea-vomiting (8.1%vs. 1.7%, P=0.023) and leukopenia (9.7%vs. 0.9%, P=0.006) were observed in the CCRT+AC group. Multivariate analysis revealed that N stage and age were significant prognostic factors for the OS of the patients with loco-regionally advanced NPC. Conclusion:The treatment outcomes of IC+IMRT and CCRT+AC were similar. Distant metastasis remained as the predominant mode of treatment failure.