The Efficacy And Toxicities Of Intensity Modulated Radiation Therapy Combined With Neoadjuvant Chemotherapy With Or Without Adjuvant Chemotherapy For Nasopharyngeal Carcinoma

【Objective】To evaluate the efficacy and radiation toxicities of intensity modulated radiation therapy(IMRT) combined with neoadjuvant chemotherapy(NACT) with or without adjuvant chemotherapy(AC) for nasopharyngeal carcinoma(NPC). 【 Materials and Methods 】 Retrospectively analyzed first diagnosed nasopharyngeal carcinoma patients with T1-2 N1-3 M0 and T3-4 N0-3 M0 who received intensity-modulated radiotherapy in our unit. A total of 187 patients were eligible. Among those patients, 140 cases were male and 47 were female. The median age of the patients was 45 years old. According to the 2008 Fuzhou nasopharyngeal carcinoma staging system, the patients number with stage II, III and IV was 15, 84 and 88 respectively.. There are 105 cases received neoadjuvant chemotherapy followed with intensity modulated radiation therapy(NACT plus IMRT) only. There are 82 cases received NACT plus IMRT followed adjuvant chemotherapy(NACT plus IMRT plus AC). 【Results】① The follow-up rate was 94%, the median follow-up time was 32 months. ② The 3-year overall survival(OS) rates of NACT plus IMRT and NACT plus IMRT plus AC group were 86.7% and 85.0%,respectively. The 5-year OS rates were 65.5% and 71.1%(P = 0.865),respectively,. The 3-year progress-free survival(PFS) rates were 76.2% and 71.0% in NACT plus IMRT and NACT plus IMRT plus AC groups, respectively(p=0.006). The 3-year recurrence-free survival(RFS), distant metastasis-free survival(DMFS) rates were 93.9% and 87.5%(P = 0.116), 79.1% and 82.1%(P = 0.576) in NACT plus IMRT and NACT plus IMRT plus AC groups. COX regression analysis showed that age(P = 0.021) and N staging(P = 0.019) were the prognosis factors for NPC patients, the greater the age or N staging, the worse prognosis. ③ Acute radiation toxicity: the incidence of bone marrow suppression in NACT plus IMRT group is higher than in NACT plus IMRT plus AC group(P = 0.022). There is no difference between the two groups in renal damage(P = 0.658), gastrointestinal tract reaction(P = 0.455), dermatitis(P = 0.441), oral mucositis(P = 0.393) and liver function damage(P = 0.298).④ Chronic radiation toxicity: The incidences of dry mouth(P = 0.031), hearing loss(P = 0.014), and lower cranial nerve injury(P = 0.029) were higher in NACT plus IMRT plus AC group than in NACT plus IMRT group. 【Conclusion】The treatment modality of NACT plus IMRT can achieve good curative effect in nasopharyngeal carcinoma(NPC) patients without distant metastases. And adjuvant chemotherapy doesn’t improve survival rate, but increase the toxicity.