Adjuvant chemotherapy following combined induction chemotherapy and concurrent chemoradiotherapy improves survival in N2–3-positive nasopharyngeal carcinoma patients

• Published in: Journal of cancer research and clinical oncology Vol. 148; no. 11; pp. 2959 - 2969
• Main Authors: Tao, Hao-Yun, Liu, Hui, He, Fang, He, Cai-Xian, Li, Ran, Du, Kun-Peng, Yuan, Ya-Wei, Zheng, Rong-Hui
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2022; Springer Nature B.V
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Research; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Chemotherapy, Adjuvant - methods; Cisplatin - adverse effects; Hematology; Humans; Induction Chemotherapy - methods; Internal Medicine; Leukopenia; Leukopenia - chemically induced; Medicine; Medicine & Public Health; Metastases; Metastasis; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - drug therapy; Nasopharyngeal Neoplasms - pathology; Neutropenia; Oncology; Original Article – Clinical Oncology; Original – Clinical Oncology; Patients; Radiation therapy; Retrospective Studies; Survival; Throat cancer; Concurrent chemo-radiotherapy; Nasopharyngeal carcinoma; Propensity score matching; Adjuvant chemotherapy; Induction chemotherapy
• ISSN: 0171-5216; 1432-1335; 1432-1335
• DOI: 10.1007/s00432-021-03846-6

Objective This study aimed to explore the clinical value of adjuvant chemotherapy (ACT) following concurrent chemo-radiotherapy (CCRT) and induction chemotherapy (ICT) in loco-regionally advanced nasopharyngeal carcinoma (LANC). Methods We included 839 newly diagnosed LANC patients in this study. ICT plus CCRT (ICT + CCRT group) was administered to 443 patients, and 396 patients received ACT after ICT plus CCRT (ICT + CCRT + ACT group). Univariate and multivariate Cox regression analyses were carried out. Furthermore, propensity score matching (PSM) was applied to balance the study and control groups. Results A total of 373 pairs of LANC patients were obtained after PSM analysis. We found that ACT following ICT + CCRT has no significant effect on improving the survival of LANC patients. By further exploring the ICT + CCRT + ACT treatment protocol, we excluded N0–1-positive patients and re-performed PSM in the ICT + CCRT and ICT + CCRT + ACT groups. Each group consisted of 237 patients. Kaplan–Meier analysis revealed that there were differences between the ICT + CCRT and ICT + CCRT + ACT groups in terms of the 5-year overall survival (OS) (78.9% vs. 85.0%, P  = 0.034), disease-free survival (DFS) (73.4% vs. 81.7%, P  = 0.029), and distant metastasis-free survival (DMFS) (84.9% vs. 76.0%, P  = 0.019). In addition, the ICT + CCRT + ACT group had a higher incidence of grade 3/4 acute leukocytopenia/neutropenia. Conclusion Compared with ICT + CCRT, ACT following ICT plus CCRT can reduce distant metastasis of N2–3-positive LANC and improve the OS and DFS. The results demonstrated the feasibility and clinical utility of ACT following ICT plus CCRT.