Comparative Analysis Of Induction Chemotherapy Plus Imrt Versus Induction-concurrent Chemoradiotherapy For Locally Advanced Nasopharyngeal Carcinoma

Objective: By retrospective analysis of clinical efficacy between induction-concurrent chemoradiotherapy and induction chemotherapy followed by intensity-modulated radiotherapy(IMRT) in patients with locally advanced nasopharyngeal carcinoma(LA-NPC), to further assess their effective and their clinical value.Methods: 200 patients who had been newly diagnosed LA-NPC in our hospital from January 2012 to July 2014 were selected, and all cases received radical dose for IMRT, paclitaxel plus cisplatin / nedaplatin were used for induction chemotherapy and concurrent chemotherapy. There were 141 males and 59 females. The median age was 46(range 15 to 70). 103 patients in stage ?and 97 cases in stage ?a. Patients were divided into two groups. For group A, there were 101 cases which underwent induction chemotherapy plus IMRT. For group B, there were 99 cases which underwent induction-concurrent chemoradiotherapy. Collected clinical data of all patients and analyzed the short-term efficacy(tumor regression in three months after radiotherapy), 1, 2-year efficacy which included overall survival(OS), local progression-free survival(LPFS), regional progression-free survival(RPFS), local regional progression-free survival(LR-PFS), distant metastasis-free survival(DMFS), progression free survival(PFS), acute and long-term toxicity, prognostic factors. SPSS18.0 statistical software was used to analyse the clinical data.Results: 1. The results showed the complete remission(CR) rate was 94.1% to primary tumor and 72.7% to cervical lymph nodes in Group A, and the corresponding rates were 92.8% and 81.7% in Group B, respectively. The overall effective rate(CR + PR) was 100%. CR rate showed no significant difference(P> 0.05) between the two groups. 2. There were no significant differences between Group A and Group B in 1-year, 2-year OS(99%vs.100%, 94.1%vs.96.8%, P=0.568); LPFS(99%vs.100%, 94.9%vs.98.5%, P=0.495); RPFS(100%vs.100%, 100%vs.98.5%, P=0.341); LR-PFS(99%vs.100%, 94.9%vs.98.5%, P=0.495); DMFS(95.7%vs.96.9%, 92.3%vs.93%, P=0.723); PFS(94.9%vs.96.9%, 87.6%vs.93%, P=0.373), respectively. 3. Multivariate analysis showed that clinical stage was independent prognostic factor for DMFS and PFS, while N stage was independent prognostic factor for OS. 4. There were higher rates of acute toxicities including leukopenia, acute oropharyngeal mucositis and neck skin reactions in Group A than those in Group A(P<0.05). There were no significant differences of anemia, thrombocytopenia and liver and kidney damage, nausea, vomiting and other gastrointestinal reactions between Group A and Group B(P>0.05). Each toxicity mainly focused on the 1/2 level, and less on grade 3, no grade 4.Conclusions:1. Compared with induction-concurrent chemoradiotherapy, induction chemotherapy plus IMRT had no significant difference in efficacy, and it had lighter toxicity. 2.Induction-concurrent chemotherapy provided no significant benefit to IMRT for LA-NPC.