A Multicenter Prospective,Randomized Study Of Intensity Modulated Radiotherapy For Locally Advanced Nasopharyngeal Carcinoma Combined With Different Chemotherapy Regimens

Objective:To evaluate the efficacy,toxicity and tolerance of nedaplatin and docetaxel induction chemotherapy plus concurrent nedaplatin with radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma(NPC).Methods:From November 2011 to November 2012,223 patients with pathologically diagnosed NPC from guangxi zhuang autonomous region 5 cancer centers were divided into 2 groups, using the random number table method,113 patients using nedaplatin(80mg/m2/di) and docetaxel(65mg/m2/di) induction chemotherapy plus concurrent nedaplatin(40mg/m2/di) with radiotherapy, the other 110 patients using cisplatin(80mg/m2/di) and docetaxel(65mg/m2/di) induction chemotherapy plus concurrent cisplatin(40mg/m2/di) with radiotherapy, two group patients adopt intensity-modulated radiation therapy.Results:After two cycle induction chemotherapy,the efficiency of nasopharyngeal lesions of the treatment group and control group were 68% and 67%(P=0.815),respectively;the efficience of lymph node lesions were 76% and 73%(P=0.613),respectively;The efficiency of 3 months after treatment in two groups is 100%(P=0.565、P=0.738). For the whole group patients,the 3-year local recurrence-free survival(LRFS),regional recurrence-free survival(RRFS),distant metastasis-free survival(DMFS),overall survival(OS) were 92.8%,93.5%,86.4%�'�87.6%,respectively.The 3-year LRFS. RRFS、 DMFS and OS of the treatment group and the control group were 93.1% and 92.8%(P=0.665),93.8% and 93.1%(P=0.666),87.2% and 85.6%(P=0.748),88.9% and 86.2%(P=0.747),respectively.There were no statistically significant difference between two groups.During treatment, the blood toxicity in test group of white blood cells, neutrophils and platelets to reduce the incidence and severity was higher than that in control group (P=0.027,0.028,0.035), hemoglobin decreased incidence and severity were lower than that of control group (P=0.000); Non hematological toxicity test group nausea/vomiting incidence and degree is lower than control group (P=0.023), the two groups had no statistically significant difference between mucositis,dermatitis and xerostomia(P=0.483、0.935,0.781).Conclusion:Treatment with nedaplatin plus docetaxel is effective and well-tolerated in patients with locally advanced NPC,the short-term efficacy between test group and control group is similar.However,nedaplatin aggravate myelosuppression except hemoglobin,which should be closely observed in the treatment.