Retrospective Analysis of the Survival Benefit of Induction Chemotherapy in Stage IVa-b Nasopharyngeal Carcinoma

• Published in: PloS one Vol. 11; no. 8; p. e0160758
• Main Authors: Lan, Xiao-Wen, Zou, Xue-Bin, Xiao, Yao, Tang, Jie, OuYang, Pu-Yun, Su, Zhen, Xie, Fang-Yun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.08.2016; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Analysis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biopsy; Cancer therapies; Carcinoma - drug therapy; Carcinoma - mortality; Carcinoma - pathology; Carcinoma - radiotherapy; Care and treatment; Chemoradiotherapy; Chemotherapy; Cisplatin - administration & dosage; Clinical trials; Diagnosis; Disease control; Disease-Free Survival; Family medical history; Female; Health aspects; Humans; Induction Chemotherapy; Intensity-modulated radiotherapy; Kaplan-Meier Estimate; Laboratories; Male; Medical imaging; Medical prognosis; Medicine and Health Sciences; Metastases; Metastasis; Middle Aged; Multivariate analysis; Nasopharyngeal cancer; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms - drug therapy; Nasopharyngeal Neoplasms - mortality; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - radiotherapy; NMR; Nuclear magnetic resonance; Oncology; Organoplatinum Compounds - administration & dosage; Patient outcomes; Patients; Physical Sciences; Radiation; Radiation therapy; Radiotherapy, Intensity-Modulated; Regression analysis; Research and Analysis Methods; Retrospective Studies; Risk; Risk factors; Risk groups; Risk reduction; Survival; Test procedures; Throat cancer; Treatment Outcome; Ultrasonic imaging; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0160758

The value of adding induction chemotherapy to chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains controversial, yet high-risk patients with LA-NPC have poor outcomes after chemoradiotherapy. We aimed to assess the survival benefits of induction chemotherapy in stage IVa-b NPC. A total of 602 patients with stage IVa-b NPC treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy with or without induction chemotherapy were retrospectively analyzed. Overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method, log-rank test and Cox regression analysis. In univariate analysis, 5-year OS was 83.2% for induction chemotherapy plus concurrent chemotherapy and 74.8% for concurrent chemotherapy alone, corresponding to an absolute risk reduction of 8.4% (P = 0.022). Compared to concurrent chemotherapy alone, addition of induction chemotherapy improved 5-year DMFS (83.2% vs. 74.4%, P = 0.018) but not 5-year LRFS (83.7% vs. 83.0%, P = 0.848) or PFS (71.9% vs. 66.0%, P = 0.12). Age, T category, N category, chemotherapy strategy and clinical stage were associated with 5-year OS (P = 0.017, P = 0.031, P = 0.007, P = 0.022, P = 0.001, respectively). In multivariate analysis, induction chemotherapy plus concurrent chemotherapy was an independent favorable prognostic factor for OS (HR, 0.62; 95% CI, 0.43-0.90, P = 0.012) and DMFS (HR, 0.57; 95% CI, 0.38-0.83, P = 0.004). In subgroup analysis, induction chemotherapy significantly improved 5-year DMFS in stage IVa (86.8% vs. 77.3%, P = 0.008), but provided no significant benefit in stage IVb. In patients with stage IVa-b NPC treated with IMRT, addition of induction chemotherapy to concurrent chemotherapy significantly improved 5-year OS and 5-year DMFS. This study provides a basis for selection of high risk patients in future clinical therapeutic trials.