TPF And GP Induction Chemotherapy Combined With Concurrent Chemoradiotherapy In Locally Advanced Nasopharyngeal Carcinoma

Objective: Analyze the efficacy and toxicities of TPF and GP regimens in the induction chemotherapy of locally advanced nasopharyngeal carcinoma.Methods:117 patients with stage III-IV nasopharyngeal carcinoma(no distant metastasis)treated in our hospital from January 2011 to December 2016 were collected retrospectively.All investigated patients were treated with 2cycles TPF or GP induction chemotherapy combined with concurrent chemoradiotherapy.Among these patients,60 were treated by GP induction chemotherapy regimen,and 57 were treated by TPF regimen.Clinical data including age,gender,TNM stage,follow-up,imaging examination and toxicities are available for all patients.SPSS software was used for statistical analysis.Results: 1.After GP induction chemotherapy,2 cases(3.3%)of nasopharyngeal lesions achieved CR,46 cases(76.7%)achieved PR and 12cases(20.0%)was SD,the total effective rate(CR+ PR)was 80.0%.After TPF induction chemotherapy,1 case(1.7%)of nasopharyngeal lesions achieved CR,45 cases(79.0%)achieved PR,11 cases(19.3%)was SD,the total effective rate(CR + PR)was 80.7%.There was no PD in both of the two groups.There was no significant difference in remission rates of nasopharyngeal lesions between GP group and TPF group(P = 0.940).2.The follow-up is up to June 2019,the median follow-up time was 53(13-102)months.In GP group and TPF group,5-year OS was 84.0% and89.8%(P = 0.323),5-year PFS was 67.2% and 80.3%(P =0.243),5-year LRFS was 87.6% and 88.6%(P =0.857),5-year DMFS was 82.6% and 92.2%(P =0.175),respectively.In the Patients of nasopharyngeal lesion with effective(CR+ PR)and nasopharyngeal lesion with SD after induction chemotherapy,the5-year OS was 90.5% and 71.4%(P =0.021),the 5-year PFS was 79.6% and49.1%(P =0.002),and the 5-year LRFS was 92.9% and 68.6%(P =0.003).Multivariate analysis showed that the remission rates of nasopharyngeal lesions(CR+ PR or SD)was an independent prognostic factor for OS(HR3.864,95% CI 1.254-11.904,P =0.019),PFS(HR 3.029,95% CI 1.436-6.390,P =0.004),and LRFS(HR 4.995,95% CI 1.585-15.746,P =0.006).3.The rate of grade 3~4 leukopenia was 61.7% in GP group and 71.9% in TPF group(P = 0.239),grade 3~4 neutropenia was 51.7% and 61.4%(P =0.288),grade 3~4 thrombocytopenia was 41.7% and 17.5%(P = 0.004),grade3~4 haemoglobin reduction was 33.3% and 10.5%(P = 0.003),respectively.There was no grade 3~4 Hepatoxicity or Kidney toxicity in both of the two groups.The rate of grade 3 ~ 4 vomiting in GP group and TPF group was15.0% and 19.3% respectively(P = 0.537);the rate of grade 3 ~ 4 oral mucositis was 13.3% and 28.1% respectively(P = 0.048).There was no case of death due to serious toxicities in both groups.Conclusion: There was no significant difference in efficacy between TPF and GP induction chemotherapy.There was no significant difference betweenthe two groups in the grade 1~2 toxicities.TPF group was more prone to have grade 3~4 radiation oral mucositis,while GP group was more prone to have grade 3~4 thrombocytopenia and hemoglobin reduction.The remission rates of nasopharyngeal lesions(CR+ PR or SD)after induction chemotherapy is an independent prognostic factor for OS,PFS and LRFS.