Concurrent chemoradiotherapy with or without adjuvant chemotherapy in intermediate and locoregionally advanced nasopharyngeal carcinoma
Concurrent chemoradiotherapy with or without adjuvant chemotherapy in intermediate and locoregionally advanced nasopharyngeal carcinoma
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DOI：
10.1007/s13277-013-0710-6
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发表时间：
2013-06-01
期刊：
影响因子：
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通讯作者：
Wang, Xiuwen
中科院分区：
文献类型：
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作者：
Zhang, Wendong;Dou, Huiqin;Wang, Xiuwen
同步放化疗（CCRT）对中期和局部晚期鼻咽癌（NPC） （II期、III期和IVA+B期）患者的疾病控制和临床结果有显著改善。然而，关于辅助化疗（AC）对CCRT方案的贡献和应用一直存在争议。本研究旨在评估AC在治疗中晚期和局部晚期鼻咽癌的毒性和临床结果方面的附加价值。回顾性分析了189例美国癌症联合委员会（AJCC） II期至IVB期鼻咽癌患者。分析患者特征、毒性、治疗依从性和临床结果，包括治疗反应、总生存期（OS）、无进展生存期（PFS）、无复发生存期（RFS）、无局部复发（FLR）和无远处转移（FDM）。CCRT组和CCRT/AC组总有效率分别为97.92%和97.83% （P = 0.643）。CCRT组5年OS率为68.2%，CCRT/AC组为75.9% （P = 0.53）。CCRT组和CCRT/AC组5年PFS分别为66.7%和71.4% （P = 0.96）。本研究没有证据表明AC在流行地区局部晚期鼻咽癌患者的疾病控制和临床结果的CCRT治疗中具有附加价值。此外，患者在CCRT后再进行三个周期的AC治疗似乎耐受性较差。因此，AC不应常规用于治疗，尽管临床试验可能是合理的。
Concurrent chemoradiotherapy (CCRT) showed a significant improvement in disease control and clinical outcome in patients with intermediate and locoregionally advanced nasopharyngeal carcinoma (NPC) (stage II, III and IVA+B). However, there has been debate about the contribution and application of additional adjuvant chemotherapy (AC) to a CCRT regime. This study aims to evaluate the additional value of AC in the treatment of intermediate and locally advanced NPC with regard to toxicity and clinical outcomes. A total of 189 patients with American Joint Committee on Cancer (AJCC) stage II to stage IVB NPC were retrospectively identified. Patient characteristics, toxicity, compliance with treatment and clinical outcomes, including response to treatment, overall survival (OS), progression-free survival (PFS), relapse-free survival (RFS), freedom from local recurrence (FLR) and freedom from distant metastasis (FDM), were analyzed. The overall response rate of CCRT and CCRT/AC groups was 97.92 % and 97.83 %, respectively (P = 0.643). The 5-year OS rate was 68.2 % in the CCRT group and 75.9 % in the CCRT/AC group (P = 0.53). The 5-year PFS rate was 66.7 % and 71.4 % in CCRT and CCRT/AC groups, respectively (P = 0.96). This study showed no evidence of an additional value of AC in CCRT treatment in disease control and clinical outcomes in patients with locally advanced NPC in endemic regions. Moreover, three additional cycles of AC after CCRT appeared to be poorly tolerated in patients. Therefore, AC should not be routinely used for treatment, although clinical trials may be justified.