Matched Analysis Of Induction Chemotherapy Plus Chemoradiotherapy Versus Induction Chemotherapy Plus Radiotherapy Alone In Locoregionally Advanced Nasopharyngeal Carcinoma: A Clinical Study

Objective: Retrospectively analyse the efficacy between induction chemotherapy plus chemoradiotherapy and induction chemotherapy plus radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma.To compare the advantages and disadvantages of these two treatments.Methods: A total of 877 patients with locally advanced NPC who underwent IC/CCRT or IC/RT at four institutions in China between January 2004 and December 2010 were retrospectively assessed.IC was cisplatin-based combination chemotherapy;concurrent chemotherapy,single agent cisplatin.Two-dimensional conventional radiotherapy(2DCRT)was the radiotherapy technique.All patients were matched in an equal ratio using a pair-matched method.Overall survival(OS),disease-free survival(DFS),distant metastasis-free survival(DMFS),locoregional relapse-free survival(LRRFS)and toxicities were assessed.Results: Eligible patients were matched(n=642;321 patients per arm)based on eight clinicopathological characteristics.Five-year OS,DFS,DMFS,and LRRFS were 76%,70%,86%,and 88% for IC/CCRT and 75%,70%,90%,and 91% for IC/RT,respectively.There were no statistically significant survival differences between arms(P>0.05),even in subgroup analysis.In multivariate analysis,treatment(IC/CCRT vs.IC/RT)was not an independent prognostic factor for any survival end-point.Grade 3/4 acute gastrointestinal toxicities(vomiting,nausea)and hematological toxicities(leucopenia/neutropenia,thrombocytopenia and anemia)were significantly more common in the IC/CCRT arm than IC/RT arm during RT.Conclusion: Overall,IC/CCRT failed to demonstrate any survival advantage but higher acute toxicities over IC/RT in locoregionally advanced NPC.