The role of concurrent chemotherapy in intensity-modulated radiotherapy for patients with stage Ⅲ nasopharyngeal carcinoma / 中华放射肿瘤学杂志

ABSTRACT

Objective:To investigate the clinical efficacy of concurrent chemotherapy in intensity-modulated radiotherapy (IMRT) for patients with stage Ⅲ nasopharyngeal carcinoma (NPC).Methods:Clinical data of 251 patients with stage Ⅲ NPC treated with IMRT alone or concurrent chemoradiotherapy (CCRT) at Sun Yat-sen University Cancer Center from February 2001 to December 2008 were retrospectively analyzed. The prognostic factors of NPC were analyzed and the efficacy of CCRT was assessed. The survival rate was calculated by Kaplan-Meier method. The differences between two groups were analyzed by log-rank test. The prognostic factors were analyzed by Cox model.Results:The 10-year locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for NPC patients were 88.6%, 81.1%, 68.8% and 75.1%, respectively. Univariate and multivariate analyses demonstrated that N staging and nasopharyngeal tumor volume were the most important prognostic factors, and concurrent chemotherapy significantly improved PFS and OS (both P<0.05). In T 3N 0-1 patients, there was no significant difference in survival indexes between IMRT alone and CCRT (10y-LRFS 93.8% vs. 93.2%, P=0.933; 10y-DMFS 80.9% vs. 86.8%, P=0.385; 10y-PFS 70.6% vs. 77.7%, P=0.513; 10y-OS 71.8% vs. 83.6%, P=0.207). For T 1-3N 2 patients, CCRT was significantly better than radiotherapy alone in LRFS, PFS, and OS (10y-LRFS 87.3% vs. 66.7%, P=0.016; 10y-PFS 70.2% vs. 41.0%, P=0.003; 10y-OS 78.5% vs. 51.7%, P=0.008), whereas there was an increasing trend in DMFS (10y-DMFS 80.3% vs. 66.4%, P=0.103). Conclusions:Concurrent chemotherapy can improve clinical prognosis of stage Ⅲ NPC patients, and the most survival benefits are obtained in the N 2 group. Individualized treatment options should be delivered based on the risk of treatment failure.