Journal
INTERNATIONAL JOURNAL OF CANCER
Volume 145, Issue 1, Pages 295-305Publisher
WILEY
DOI: 10.1002/ijc.32099
Keywords
nasopharyngeal carcinoma; induction chemotherapy; concurrent chemoradiotherapy; randomized clinical trial
Categories
Funding
- Shenzhen Main Luck Pharmaceuticals Inc., Sun Yat-sen University Clinical Research 5010 Program [2007037]
- National Natural Science Foundation of China [81702682]
- Special support program of Sun Yat-sen University Cancer Center [16zxtzlc06]
- Natural Science Foundation of Guang Dong Province [2017A030312003]
- Health & Medical Collaborative Innovation Project of Guangzhou City [201803040003]
- Innovation Team Development Plan of the Ministry of Education [IRT_17R110]
- Overseas Expertise Introduction Project for Discipline Innovation [B14035]
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To report long-term results of a randomized controlled trial that compared cisplatin/fluorouracil/docetaxel (TPF) induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) with CCRT alone in locoregionally advanced nasopharyngeal carcinoma (NPC). Patients with stage III-IVB (except T3-4 N0) NPC were randomly assigned to receive IC plus CCRT (n = 241) or CCRT alone (n = 239). IC included three cycles of docetaxel (60 mg/m(2) d1), cisplatin (60 mg/m(2) d1), and fluorouracil (600 mg/m(2)/d civ d1-5) every 3 weeks. Patients from both groups received intensity-modulated radiotherapy concurrently with three cycles of 100 mg/m(2) cisplatin every 3 weeks. After a median follow-up of 71.5 months, the IC plus CCRT group showed significantly better 5-year failure-free survival (FFS, 77.4% vs. 66.4%, p = 0.019), overall survival (OS, 85.6% vs. 77.7%, p = 0.042), distant failure-free survival (88% vs. 79.8%, p = 0.030), and locoregional failure-free survival (90.7% vs. 83.8%, p = 0.044) compared to the CCRT alone group. Post hoc subgroup analyses revealed that beneficial effects on FFS were primarily observed in patients with N1, stage IVA, pretreatment lactate dehydrogenase >= 170 U/l, or pretreatment plasma Epstein-Barr virus DNA >= 6000 copies/mL. Two nomograms were further developed to predict the potential FFS and OS benefit of TPF IC. The incidence of grade 3 or 4 late toxicities was 8.8% (21/239) in the IC plus CCRT group and 9.2% (22/238) in the CCRT alone group. Long-term follow-up confirmed that TPF IC plus CCRT significantly improved survival in locoregionally advanced NPC with no marked increase in late toxicities and could be an option of treatment for these patients.
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