Comparison Of Nutritional Status,Side Affects And Short-term Efficacy Of Induction Chemotherapy Sequential Chemoradiation VS Induction Chemotherapy Plus Radiotherapy For Locally Advanced Nasopharyngeal In The IMRT Era

Objective: To compare and analysize the nutritional status,acute adverse reactions and short-term efficacy of induction chemotherapy sequential chemoradiation vs induction chemotherapy plus radiotherapy for locally advanced nasopharyngeal in the era of IMRT.Methods:According to the standard we set,247 cases of patients with nasopharyngeal carcinoma diagnosed and given treatment in fujian provincial tumor hospital from October 2015 to June 2016 were retrospectively analyzed.We divided them into two groups,one is induction + concurrent chemoradiotherapy group(172 pts),and the other induction + radiotherapy group(75pts).All patients were received the platinum-based induction chemotherapy and intensity-modulated radiotherapy,while,IC+CCRT group of patients received platinum for single or joint use for synchronous chemotherapy during radiotherapy.The data of Height,weight,total protein,albumin,prealbumin and other nutritional related indexes were collected at the timing of pre-treatment,post-indution but pre-radiotherapy and the period of the radiotherapy.We chose the worst outcome as what we wrote down on the list.We adopted CTCAE v3.0 as evaluation scale to record the acute toxicities,including stomatitis,dry mouth,radioactive dermatitis,bone marrow suppression,gastrointestinal reactions,anemia,liver and kidney dysfunction,also,the worst results were recorded.Within 3 months after the treatment RECIST1.1 standard was used to evaluate the short-term efficacy of all patients.Data processing analysis was finished well with the help of SPSS22.0 software package.We compare the nutritional status of two groups before treatment,pre-radiotherapy,the results of shor-term efficacy and side effects with the Mann-Whitney U method.What we used to analyze the variance of the nutriture of pre and post not only induction chemotherapy but also radiotherapy is Wilcoxon test.Principal component analysis and Speaeman method were imported to build the index N and conduct correlation analysis respectively.Results:there was no significant difference between the IC+CCRT group and IC+RT group in the terms of sex,age,pathological type,T,N,clinical stages.Before the treatment,on respect of BMI,total protein,albumin,prealbumin,no statistical difference was existed in both groups.Based on the analysis of nutriture pre and post treatment,Not only the total but also the between-gourps was inclined to decline.With the median is described,in IC+CCRT group,the change of BMI,total protein,albumin,prealbumin,showed a value of 1.29(Kg/m2),3.60(g/L),3.10(g/L),100.50(mg/L),significantly greater than the IC+RT group,whose data was 0.40(Kg/m2),1.40(g/L),2.00(g/L),85.00(mg/L),P < 0.05.Referring to the whole,85.8% of patients suffered a weight loss during the course of therapy,at meanwhile 47.0% of whom had a 5% loss or more.In IC+CCRT group,the weight loss of 5% or more,occupied a proportionof 55.8%,corresponding to 26.7% in IC+RT group,P < 0.001.Nutrition Index N=0.494*X1+0.831*X2+0.791*X3+0.555*X4,X1=BMI,X=2albumin,X3=preal bumin,X4=total protein.With N = 250.499 as a malnutrition cut-off value,the malnutrition rate of IC+CCRT group after treatment was 75.0%,58.7% in the IC+RT group,and the differences were statistically significant.In terms of compliance,the interruption rate of treatment of IC+CCRT group was 3.49%,which of IC+RT group was 2.67%,no statistical difference existed.When it comes to acute toxicity,IC+CCRT group in the incidence of anemia,stomatitis,bone marrow suppression,the severity of radioactive dermatitis,gastrointestinal reaction group were significantly higher than that of IC+RT group,whereas no differences in the liver and kidney dysfunction,dry mouth.Among them,the propotion of patients sustaining stomatitis with the grade 3 or higher,IC+CCRT group was 12.2% VS IC+RT group 5.3%(P<0.05);14.0% VS5.3 % in bone marrow suppression with grade3(P<0.05);10.5% VS6.7 % in grade 2 gastrointestinal reaction(P<0.05).Related analysis revealed that there was a negative correlation beteewn the nutrition index N and some adverse affects(including stomatitis,Bone marrow suppression and Gastrointestinal reaction).As for the short-term efficacy of the two groups,overall efficient namely(CR + PR)rate were 100%.For primary tumors,in IC+CCRT group,CR rate was 84.9% and the PR rate is 15.1%,while the IC+ RT group is 81.3%,18.7%.Conclusions:In the era of IMRT,for patients with locally advanced nasopharyngeal carcinoma,induction + chemoradiatherapy didn’t behave better than induction + radiotherapy in the outcome of short-term efficacy.What’s worse,it delivered a more serious acute toxicities and poor nutritional status.Noteworthy,there is a negative correlation relationship between the nutritional status and stomatitis,myelosuppression,and gastrointestinal reaction.For patients with stage III to IV NPC,the role of chemoradiation is debatable,and more focus should be put on the nutritional status of cancer patients.