Compare The Long-term Efficacy Of Neoadjuvant Chemotherapy Plus Concurrent Chemoradiotherapy And Concurrent Chemoradiotherapy Alone For Locoregionally Advanced Nasopharyngeal Carcinoma

Objective: A retrospective analysis was performed on the clinical data of the patients with locoregionally advanced nasopharyngeal carcinoma(LANPC ) .To compare the long-term efficacy between two radiochemotherapy regimens for LANPC : intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy(CCRT) versus neoadjuvant chemotherapy (NACT) followed by CCRT.Materials and Methods: A retrospective analysis was performed on the clinical data of 224 patients with LANPC who were admitted to The First Affiliated Hospital of Guang xi medical University from October 2008 to December 2010. Of the 224 patients, 118 were treated with NACT+CCRT(NACT group) and 106 received CCRT alone (CCRT group). The NACT group received a regimen that included TP(docetaxel and cisplatin)or PF (cisplatin and 5-fluorouracil). The CCRT group received cisplatin concurrently with radiotherapy. All patients were received IMRT while they were not treated with adjuvant chemotherapy. The long-term curative effect and treatment toxicity were compared between the two groups.The SPSS 19.0 statistical software was used. A two-tailed P value of less than 0.05 was considered significant.Results : The 5-year overall survival(OS),relapse-free survival(RFS),distant metastasis-free survival(DMFS) , and disease-free survival (DFS)were 83.0%?93.7%?87.1% and 83.1%,respectively.There were no significant differences between the NACT group and CCRT group in 5-year OS(83.9 vs. 82.1%,P=0.768), RFS(96.4%vs. 90.8%, P=0.114),DMFS(89.5%vs. 84.5%, P=0.264), and DFS(86.1 % vs. 79.8%,P=0.216) .Subgroup analysis showed that NACT did not significantly improve 5-year OS?RFS?DMFS?DFS in T3-4N0-1 patients or T1-4 N2-3 patients. In a comparison of patients treated with TP and PF,there were not statistically different.The use of NACT resulted in significantly higher overall risk of severe hematologic toxicity(leucopeni?neutropenia?decrease in hemoglobin?thrombocytopenia) and archenteric untoward (nausea?emesis) during the treatment course compared to patients treated by CCRT alone.There was significant difference between two groups(P=0. 021?0. 017?0.010?0.048?0. 040<0. 05).Conclusions: The NACT usage failed to provide improvement in survival in patients with LANPC while significantly increasing the risk of severe hematologic toxicity and archenteric untoward. Further randomized clinical trials are still necessary to clear the role of NACT in the treatment of LANPC.