| ObjectiveTo investigate the efficacy,tolerance and optimal maintenance time of S-1 oral maintenance chemotherapy(MC)after definitive chemoradiotherapy for stage N3M0nasopharyngeal carcinoma.Materials and MethodA total of 304 Patients with stage T1-4N3M0(AJCC 8th)nasopharyngeal carcinoma who were first diagnosed in Fujian Cancer Hospital from May 2014 to December 2017were conducted,of whom 56 patients received S-1 oral MC after definitive chemoradiotherapy(CRT-MC),and 248 patients did not receive(CRT-non-MC).All enrolled patients received definitive chemoradiotherapy.The short-term efficacy was evaluated 4-6 weeks after definitive chemoradiotherapy.After the completion of the short-term efficacy evaluation,patients accepted S-1 MC or not,and S-1 dose was given in accordance with different body surface area:40mg/time twice daily for body surface area<1.25m~2,50mg/time twice daily for body surface area≥1.25m~2<1.5m~2,60mg/time twice daily for body surface area≥1.5m~2,oral administration,the patients were treated with medication from day 1 to day 14,with a cycle of 28 days(referred to as a 2+2regimen).General continuous use of drugs for 12 or 24 months,MC was stopped early when the toxic reactions related to maintenance therapy were intolerable or the disease progressed.Analyze the efficacy and tolerability of definitive chemoradiotherapy following S-1 oral MC of N3M0 nasopharyngeal carcinoma.Record the toxic reactions during maintenance therapy period.According to the number of maintenance chemotherapy cycles,the patients in CRT-MC cohort were divided into three groups:maintenance chemotherapy<12 cycles,maintenance chemotherapy 12-23 cycles and maintenance chemotherapy≥24 cycles.The best maintenance treatment time for N3M0nasopharyngeal carcinoma was analyzed.ResultThe median follow-up time was forty-eight months,significant differences in 4-years OS(74.9%vs.91.7%,P=0.003),4-years PFS(60.7%vs.83.7%,P=0.001)and 4-years DMFS(68.8%vs.85.5%,P=0.015)were observed between the CRT-non-MC and CRT-MC cohorts,MC after definitive chemoradiotherapy improve the survival of OS,PFS,DMFS,but not LRRFS(88.2%vs.96.2%,P=0.072).The univariate and multivariate analyses revealed that MC was the independent factor that significantly influenced OS,PFS,and DMFS(HR=0.185,95%CI:0.058-0.591,P=0.004;HR=0.320,95%CI:0.160-0.640,P=0.001;HR=0.348,95%CI:0.166-0.726,P=0.005),short-term treatment response was the independent factor that significantly influenced OS,PFS and DMFS(HR=2.338,95%CI:1.327-4.121,P=0.003;HR=2.627,95%CI:1.658-4.160,P<0.001;HR=2.315,95%CI:1.394-3.843,P=0.001),In addition,sex was the independent factor that significantly impacted PFS(HR=0.574,95%CI:0.350-0.941,P=0.028).No grade 3/4 toxicity or treatment-related deaths occurred during MC,toxic reactions include myelosuppression(42.8%),skin hyperpigmentation(39.3%)and gastrointestinal reactions(33.3%)were common side effects of MC.The 3-year PFS of the three groups of maintenance chemotherapy<12 cycles,maintenance chemotherapy 12-23 cycles,and maintenance chemotherapy≥24 cycles were 67.9%,92.9%and 94.4%,respectively,and3-year DMFS were 67.9%,100%,and 94.4%,respectively.The 3-year PFS and DMFS between the 12-23 cycles of maintenance chemotherapy and the maintenance chemotherapy≥24 cycles group are similar.The OS,PFS and DMFS were significantly higher for patients who received S1 administration over a period of≥12 cycles compared with those who received<12 cycles(3-year OS 100%vs.87.5%,P=0.018,3-year PFS93.9%vs 67.9%,P=0.006,3-year DMFS 97.1%vs 67.9%,P=0.002).ConclusionOn the basis of systemic chemotherapy,using the 2+2 regimen of S-1 oral maintenance chemotherapy following definitive chemoradiotherapy with N3M0nasopharyngeal carcinoma is safe,effective,and well tolerated.It is recommended that S1 should be maintained for≥12 cycles. |
PDF Full Text Request