Discussion On The Comprehensive Treatment Mode Of Locally Advanced Nasopharyngeal Carcinoma

Purpose To evaluate the efficacy and the toxicities of IMRT combined with concurrent chemotherapy followed by adjuvant chemotherapy compared with IMRT combined with concurrent chemotherapy alone in patients with locally advanced nasopharyngeal carcinoma.Methods From January 2007 to December 2014,we collected797 stagedⅡ-Ⅳb [UICC= Union for International Cancer Control criteria(7th edition)] NPC patients for analysis.After 1:1 matching,we selected 261 cases as the CCRT group,another 261 patients as theCCRT+AC group.Using Kaplan-Meier to calculate the overall survival(OS),locoregional failure-free survival(LFFS),distant metastasis failure-free survival(DMFS).The log-rank test and Cox-proportional hazards model to evaluate the prognostic factors.Results After matching,261 patients were involved in each group.In CCRT+AC group,The 1-,2-and 3-year os rates were a little higher than in CCRT group(99.6% vs 97.9%,97.4% vs 96.2%,93.8% vs86.9%,P=0.150).There were no significant difference in 1-,2-,3-year OS,LFFS,DMFS between the two groups.From subgroup analysis,concurrent chemotherapy followed by adjuvant chemotherapy can significantly improved the OS for T4 NPC patients(P=0.001).For acute adverse reactions,there were 8(3.1%)patients with grade 3-4gastrointestinal reaction and 56(21.5%)patients with Leukopenia,32(12.3%)patients were with grade 3-4 skin and oral mucositis in CCRT group.In CCRT+AC group,8(3.1%)patients were with grade 3-4gastrointestinal reaction and 70(26.8%)patients with Leukopenia.30(11.5%)patients were with grade 3-4 skin and oral mucositis,there was no significantly difference in the acute side effects between the two groups(P=1.000,P=0.152,P=0.787).Conclusion IMRT combined with concurrent chemotherapy followed by adjuvant chemotherapy did not significantly improved1-,2-,3-year of OS in locally advanced nasopharyngeal carcinoma.However,for T4 NPC patients,adjuvant chemotherapy can improved their overall survival rate.But it still needs longer follow-up time and more studies to confirm the conclusion.Using adjuvant chemotherapy in locally advanced NPC is safety and acceptable.Objective Retrospectively comparing the efficacy and toxicities of intensity-modulated radiotherapy(IMRT)combined with concurrrent chemotherapy and cetuximab or nimotuzumab +/-adjuvant chemotherapy,or IMRT combined with concurrent chemotherapy +/-adjuvantchemotherapy.To evaluate the necessity of adding cetuximab or nimotuzumab on the basis of standard chemoradiotherapy.Methods From 2007 to 2014,a total of 42 nasopharyngeal carcinoma(NPC)patients of stage Ⅲ and Ⅳb(china criteria 2008 version)who treated with IMRT combined with cetuximab or nimotuzumab +concurrent chemotherapy +/-adjuvant chemotherapy(study group)were collected,Another 168 patients treated with IMRT + concurrent chemotherapy +/-adjuvant chemotherapy(control group)were matched1:4 with the study group.Retrospectively Analysis the overall survival(OS),locoregional failure-free survival(LFFS),distant metastasis failure-free survival(DMFS)and the acute adverse events in the two groups,to compare the efficiency and safety in both groups.Results Median follow-up was 38.65 months(range 6.13-95.63).The follow-up rate was 100.0%.22 patients were dead.8patients were recurrence and 17 patients were with distant metastasis.The3-year OS rates,the LFFS rates,and the DMFS rates of study group were94.3%、100.0% and 92.2%,respectively.In control group,The rates were87.3%,94.6% and 89.1%,respectively.No significant difference was observed between the two groups(P=0.647,P=0.193,P=0.744,respectively).In study group,stomatitis was the most common acute treatment toxicity.3(7.1%)patients were with grade 3-4 gastrointestinal reaction and 11(26.2%)patients with Leukopenia,7(40.5%)patients werewith grade 3-4 oral mucositis.In control group,6(3.6%)patients were with grade 3-4 gastrointestinal reaction and 29(17.3%)patients with Leukopenia.25(14.9%)patients were with grade 3-4 oral mucositis,There was no significantly different in gastrointestinal reaction and Leukopenia(P=0.388、P=0.272),but we observed significant different in oral mucositis(P=0.000).Conclusions From the results,adding cetuximab or nimotuzumab on the basis of IMRT combine with chemotherapy can not significantly improve the OS rate,LFFS rate,DMFS rate in locally advanced nasopharyngeal carcinoma.In addition,it may aggravated radiation-induced oral mucositis.