Nimotuzumab Plus Radiotherapy After Induction Chemotherapy In Locally Advanced Nasopharyngeal Carcinoma: A Retrospective Analysis

Objective:1.To compare the near and long term outcomes and toxicities between nimotuzumab combined with radiotherapy(NRT)after induction chemotherapy(IC)(IC+NRT)and concurrent chemoradiotherapy(CRT)after induction chemotherapy(IC)(IC+CRT)in patients with locoregionally advanced nasopharyngeal carcinoma(NPC).2.To explore factors associated with prognosis in patients with locoregionally advanced nasopharyngeal carcinoma treated with nimotuzumab.Method:Based on the inclusion and exclusion criteria,the data of 121 patients with locoregionally advanced NPC who were first diagnosed and treated at The First Affiliated Hospital of Nanchang University hospital from January 1,2017 to December 31,2017 were retrospectively reviewed.Objective response rate(ORR),disease-free survival(DFS),overall survival(OS),locoregional relapse-free survival(LRRFS),distant metastasis-free survival(DMFS)and differences in early and late toxicities were compared between the study group(IC+NRT)and the control group(IC+CRT).Subgroup analysis was performed on the study group to compare the effects of different age,gender,pathological classification,TNM stage,lactate dehydrogenase(LDH)quantification,Epstein-Barr Virus(EBV),induction chemotherapy regimen,number of induction chemotherapy and whether adjuvant chemotherapy on patients’ survival prognosis.Result:121 patients were included in this study,including 25 patients in IC + NRT group and 96 patients in IC + CRT group.Recent efficacy: ORR was 96% in IC+NRT group and 95% in IC+CRT group,with no significant difference between the two regimens(P=0.804).Long term outcomes: the 3-year DFS was 75.8% vs 74.5% in the IC+NRT and IC+CRT groups,with no significant difference in 3-year DFS between the two groups(P=0.766);the 3-year OS was 79.5% vs 89.3% in the IC+NRT and IC+CRT groups,with no significant difference in 3-year OS between the two groups(P=0.184);the 3-year LRRFS was 79.1% vs 86.8% in the IC+NRT and IC+CRT groups,with no significant difference in 3-year LRRFS between the two groups(P=0.302),the 3-year DMFS was 79.0% vs 84.8%,with no significant difference in3-year DMFS between the two groups(P=0.565).Toxicities: leukopenia: Grade I/II and III/IV reactions occurred in 28.0% and 0.0% of IC+NRT group compared to 44.8%and 6.3% of IC+CRT group,with a significant difference between the two groups(P=0.013).Radiation mucositis: the incidences of grade I/II and III/IV reactions were44.0% and 48.0% in the IC+NRT group and 69.8% and 24.0% in the IC+CRT group,with a significant difference between the two groups(P=0.047).No significant differences were observed in the remaining toxicities.In the subgroup analysis of the study group,T4 stage was an independent high-risk factor affecting the prognosis of LRRFS and OS in this group of patients.Conclusions:1.For patients with locoregionally advanced NPC,the combination of nimotuzumab and radiotherapy after induction chemotherapy was non inferior to that of concurrent chemoradiotherapy after induction chemotherapy in terms of both short-term outcomes and long-term survival benefits,and nimotuzumab was milder in terms of haematological toxicity than concurrent chemotherapy,but the incidence of radiation mucositis was worse than concurrent chemotherapy.2.For patients with nimotuzumab using,T4 stage was an independent prognostic high-risk factor for both LRRFS and OS in patients with locoregionally advanced NPC.