Cancer Res Treat.  2016 Jul;48(3):917-927. 10.4143/crt.2015.265.

The Role of Neoadjuvant Chemotherapy in the Treatment of Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Study (KROG 11-06) Using Propensity Score Matching Analysis

• Song JH
• Wu HG
• Keam BS
• Hah JH
• Ahn YC
• Oh D
• Noh JM
• Park HJ
• Lee CG
• Keum KC
• Cha J
• Cho KH
• Moon SH
• Kim JY
• Chung WK
• Oh YT
• Kim WT
• Cho MJ
• Kay CS
• Kim YS

• KMID: 2344064
• DOI: http://doi.org/10.4143/crt.2015.265

Abstract

PURPOSE
We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm).
MATERIALS AND METHODS
A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed.
RESULTS
After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018).
CONCLUSION
This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.

Keyword

Nasopharyngeal neoplasms; Chemoradiotherapy; Induction chemotherapy; Radiotherapy; Republic of Korea

MeSH Terms

Arm
Chemoradiotherapy
Compliance
Disease-Free Survival
Drug Therapy*
Humans
Induction Chemotherapy
Methods
Nasopharyngeal Neoplasms
Propensity Score*
Radiotherapy
Recurrence
Republic of Korea
Retrospective Studies*
Standard of Care
Treatment Outcome

Figure

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  Fig. 1. Overall survival (OS) (A), disease-free survival (DFS) (B), locoregional failure-free survival (LRFFS) (C), and distant failure-free survival (DFFS) (D) curves for the concurrent chemoradiotherapy arm (CRT) and neoadjuvant chemotherapy arm (NCT) arms in the propensity-matched cohort.

• 

  Fig. 2. Overall survival (OS) (A), disease-free survival (DFS) (B), locoregional failure-free survival (LRFFS) (C), and distant failure-free survival (DFFS) (D) curves for the concurrent chemoradiotherapy arm (CRT) and neoadjuvant chemotherapy arm (NCT) arms in subgroup with stage IV disease patients younger than 60 years.

Reference

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