ABSTRACT
Objective:To evaluate the efficacy of intensity-modulated radiation therapy (IMRT) combined with chemotherapy for treating patients with T 1-2N 1M 0 nasopharyngeal carcinoma (NPC). Methods:343 patients diagnosed with T 1-2N 1M 0 NPC in Zhejiang Cancer Hospital and Sun Yat-sen University Cancer Center from January 2008 to December 2016 were recruited in this study. All patients received IMRT and divided into the radiotherapy (RT) and chemoradiotherapy (CRT) groups. Patients in the CRT group were further assigned into the concurrent chemoradiotherapy (CCRT), induction chemotherapy+ CCRT (IC+ CCRT) and CCRT+ adjuvant chemotherapy (AC) groups. Locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) were estimated by Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox models. Results:The median follow-up time for surviving patients (303/343) was 91(range: 49-138) months. The 5-year OS, CSS, PFS, LRFFS, and DMFS rates in the CRT group were not superior to those of the RT group (93.7%: 93.9%, 93.7%: 93.9%, 89.0%: 87.7%, 93.8%: 92.8%, 93.8%: 91.2%, all P>0.05). No significant difference was found in treatment outcomes of patients with T 1N 1 or T 2N 1 NPC between two groups (all P>0.05). In multivariable analyses, only age was an independent prognostic factor for OS, PFS, CSS and DMFS, and negative correlation was found between them. No survival benefits were achieved in the CCRT, IC+ CCRT, CCRT+ AC and RT groups, and no significant differences were found in clinical efficacy among the three combined (all P>0.05). Conclusions:IMRT alone yields comparable clinical efficacy to CRT in treating patients with T 1-2N 1M 0 NPC. However, whether CT can be eliminated in the T 1-2N 1M 0 population still needs further confirmation by prospective, randomized and controlled clinical trials.
ABSTRACT
Nasopharyngeal carcinoma (NPC) is one of the common head and neck malignant tumors. Radiotherapy is the main treatment for NPC. The comprehensive application of chemotherapy strategies (induction, concurrent and adjuvant) in radiotherapy has improved the efficacy in the treatment of locally advanced NPC. Based on current evidence, concurrent chemoradiotherapy combined with adjuvant or induction chemotherapy has been recommended as the standard treatment for locally advanced NPC. However, there are still many deficiencies in the standard treatment, and the application of induction and adjuvant chemotherapy remains controversial. Establishing a more ideal and individualized chemoradiotherapy for locally advanced NPC is still the research direction in the future.