| [Background]Nasopharyngeal carcinoma is a high-risk tumor in southern China,and the combination of radiotherapy and chemotherapy is the preferred treatment for locally advanced nasopharyngeal carcinoma(LANPC).More and more studies have shown that induction chemotherapy(IC)followed by concurrent radiochemotherapy(CCRT)can significantly improve survival benefits and reduce local recurrence.The combination of docetaxel,cisplatin and fluorouracil(TPF)has achieved good therapeutic effects.However,cisplatin has obvious treatment-related short-term and long-term toxicity,and the drug usage is relatively cumbersome.In TP or PF dual-drug IC followed by CCRT and simple CCRT,nedaplatin significantly reduced the toxicity of cisplatin and did not reduce its clinical efficacy.Nedaplatin became a cisplatin replacement for patients with NPC.[Objective]To explore the clinical efficacy and acute toxicity of IC with docetaxe,fluorouracil plus nedaplatin or cisplatin followed CCRT with nedaplatin or cisplatin for LANPC.[Methods]A total of 269 initially diagnosed patients with LANPC who were hospitalized in our hospital from June 2012 to June 2017 were selected,including 214 males and 55 females.The median age was 47 years(19-70 years).patients were divided into stage III(148 patients;55.0%)and stage IVa(121patients;45.0%).According to the chemotherapy regimen,it was divided into TNF + N group: docetaxel combined with nedaplatin and fluorouracil followed by nedaplatin CCRT group(n = 146),and TPF + P group: docetaxel combined with cisplatin and fluorouracil followed by cisplatin CCRT group(n=123).Kaplan-Meier method and Cox proportional hazards model were used to analyze survival rate and prognostic factors.After a 1: 1 propensity scores matching(PSM),there were 113 patients in each group.The Chi-square test or Fisher’s exact test was used to compare the acute toxicity between the two groups.[Results]The 3-year overall survival(OS),progression free survival(PFS),distant metastasis-free survival(DMFS),and local recurrence-free survival(LRRFS)of the two groups were: 90.7% vs.92.3%(p = 0.315),78.9% vs.79.4%(p = 0.715),82.4% vs.85.1%(p = 0.441)and 96.1% vs.93.3%(p = 0.414),There was no significant difference in the 3-year related survival index between the two groups of patients.This survival result was fully confirmed by PSM analysis.In acute toxicity,the TPF + P group was more likely to have grade 3 or 4 vomiting than the TNF + N group(22.1% vs.0%,p<0.01),and the TNF + N group had more grade 3 or 4 thrombocytopenia than the TPF + P group(15.9% vs.6.2%,p=0.020),this difference was mainly occurred during CCRT(1 case in TPF + P group and 0 case in TNF + N group during IC).In addition,compared with the TPF + P group,the incidence of grade 3 or 4 leukopenia and neutropenia was higher during CCRT in the TNF + N group(36.3% vs.22.1%,p=0.019;31.0% vs.16.8%,p=0.013).[Conclusion]The efficacy of TNF+N regimen for LANPC is equal to that of TPF+P regimen,and the incidence of grade 3 or 4 vomiting is lower.TNF+N regimen may be an option for the treatment of patients with LANPC.Although the TNF+N regimen had a lighter vomiting response,the severe hematological toxicity was significantly increased during the CCRT,the incidence of grade 3 or 4 thrombocytopenia,leucopenia,and neutropenia was significantly higher in the TPF + P group,it is suggested that increasing the cumulative dose of nedaplatin has the risk of delayed hematological toxicity,and it should be treated with caution in the clinic.Comparing the shortcomings of the two regimens,whether it is possible to consider the cisplatin followed by nedaplatin(cisplatin for IC and nedaplatin for CCRT,ie TPF + N combination)is more reasonable and needs further clinical research to prove. |
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