| objective: Induction chemotherapy followed by concurrent chemoradiotherapy is one of the treatment options for locally advanced nasopharyngeal carcinoma.The role of gemcitabine plus cisplatin(GP)regimen in induction chemotherapy(IC)is uncertain.The current study aimed to investigate the efficacy of GP regimen in tumor volume reduction after IC and compared it with TP(paclitaxel plus cisplatin)IC regimen.The early survival and acute toxicity during radiotherapy and chemotherapy of two groups of patients were also reported.Methods : The cases of locally advanced nasopharyngeal carcinoma(NPC)treated with GP regimen induction chemotherapy in Sichuan Cancer Hospital were analyzed retrospectively.According to the characteristics of T stage and clinical stage,TP regimen induction chemotherapy cases were matched.The median time between completion of the second course of chemotherapy and post-chemotherapy MRI and between pre-chemotherapy and post-chemotherapy MRI were 9±8 and 46±8 days for the GP group and 15±7 and 45±11 days for TP group,respectively.There were no statistically significant differences in the time length between the two groups(p>0.05)。The gross tumor volume of the primary site,positive lymph nodes,and nasopharyngeal air cavities were delineated according to magnetic resonance imaging before and after IC.The degree of regression in volume [DRV,defined as(pre-GTV-post-GTV)/ pre-GTV ] for primary tumor and positive lymph node,and changes in volume of nasopharyngeal air cavity after IC were calculated and compared between two groups.The experiment was conducted through case review,telephone,outpatient service and letters and visits.SPSS statistical software package was used for statistical analysis,T test,chi-square test and Kaplan-Meier survival curve were used to analyze acute toxicity and early survival results by logarithmic rank test.Results: From January 2014 to July 2017,44 patients with stage III-IVB nasopharyngeal carcinoma received GP regimen induction chemotherapy.Among 86 patients who received TP induction chemotherapy,44 patients were matched according to their clinical characteristics form TP group.The final 88 patients were included in the study.The mean volumes of the the primary site in the TP and GP groups before IC were 94.59(range,38.70–170.16)ml and 102.20(range,28.55–190.86)ml,respectively.The mean volumes of the lymph nodes in the TP and GP groups before IC were 13.63(range,0.79–196.84)ml and 7.96(range,0.66–32.24)ml respectively.The mean volumes of the nasopharyngeal cavity in the TP and GP groups before IC were 4.70(range,1.51–11.40)ml and 3.96(range,0–8.98)ml respectively.There were no differences in the pre-treatment tumor volume and nasopharyngeal cavity between two groups(p>0.05).DRV for the primary site,lymph nodes,and volume of nasopharyngeal cavity were 31.89%(range,-1.96-89.92%),46.07%(range,-23.15-93.28%)and 2.62(range,0.1-7.63)ml for GP group,23.07%(range,-35.81-58.45%),33.11%(range,-47.26-68.87%)and 1.47(range,-2.47-6.17)ml for TP group.All comparisons favored the GP regimen,the P values were 0.03,0.02,and 0.003,respectively.The toxicities of the two regimens were comparable.Most of patients have follow up less than 2 years(median,18.7 months),for the entire cohort,the 1-year OS,disease-free survival(DFS),locoregionally free survival(LRFS)and distant metastasis-free survival(DMFS)rates were 96.5%,95.7%,98.5% and 97.2%,respectively.The 1-year OS(TP vs.GP,97.3% vs.95%),DFS(94.9% vs.96.9%),LRFS(97.4% vs.100%),DMFS(97.5% vs.96.9%)and no survival differences were observed yet(p= 0.69、0.49、0.40、0.76).Conclusion: The two groups were similar in acute toxicity.Changes in the tumor volume and nasopharyngeal air cavity showed that the GP regimen was significantly more effective than the TP regimen in tumor burden reduction.However,whether the advantages of GP can translate into survival benefits requires further investigation. |
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