Comparision Of Effectiveness And Toxicity Of Different Chemotherapy Regimens Combined With Radiotherapy For Locoregionally Advanced Nasopharyngeal Carcinoma

Objective To compare the efficacy and toxicity of different concurrent chemoradiotherapy with cisplatin or cisplatin plus Fluorouracil in patients with locoregionally advanced nasopharyngeal carcinoma.Methods A total of 160 patients with locoregionally advanced NPC (classified as stage III-IVB by the AJCC 7th Edition) seen at our institution between January 2005 and December 2011 were reviewed. The patients were treated with concurrent chemoradiotherapy with cisplatin(DDP) or cisplatin plus fluorouracil(PF). All patients were treated by definitive-intent radiation therapy or Intensive modulated radiation therapy. The DDP patients received concurrent cisplatin (80-100mg/m2 iv dl-d3) every 3 weeks for 1-3 cycles during RT,The PF patients received cisplatin (80mg/m2 iv d1-d3) plus fluorouracil (750 mg/m2/d iv 96h) every 3 weeks for 1-3 cycles during RT. Survival and toxicity were reported.Results After a median follow-up time of 55 months, The 5-year overall survival rates (OS) was 73.3% for the DDP group,and 63.5% for the PF group (P=0.36). The locoregional relapse-free survival rates (LRFS) was 90.9% for the DDP group, and 84.6% for the PF group (P=0.12). The distant metastasis-free survival rates (DFS) was 85.6% for the DDP group,and 78.3% for the PF group (P=0.37),while the failure free survival rates (FFS) for the DDP group was 78.5%,compared with 72.5% for the PF group (P=0.34). No significant difference was found between patients treated with either concurrent regimens. In multivariate analysis,the age was an independent adverse factor in overall survival (hazard ratio,2.02;95% CI,1.21-3.40;P=0.01),the radiotherapy was an independent adverse factor in distant metastasis-free survival rates (hazard ratio,2.92;95% CI,1.24-6.85;P=0.01) and failure free survival rates(hazard ratio,2.89;95% CI,1.31-6.38;P=0.01).The main toxicities were oral mucositis,nausea/vomiting and leucopenia,There were more oral mucositis in the PF groupthan that in the DDP group (P<0.05).Compliance of the DDP group was better than the PF group.Conclusions The efficacy of DDP and PF concurrent chemoradiotherapy regimens were found similar in patients with locoregionally advanced NPC.The oral mucositis in the group of PF are relatively heavy but acceptable.Compliance of the DDP group was better than the PF group.