Lan XW, et al. – This study investigated whether adding induction chemotherapy to concurrent chemoradiotherapy improved survival in stage III nasopharyngeal carcinoma (NPC) patients, especially in low–risk patients at stage T3N0–1. In stage T3N0–1 NPC patients treated with intensity-modulated radiation therapy (IMRT), the addition of induction chemotherapy (IC) to concurrent chemotherapy (CC) did not significantly improve their survival. Data depicted higher rates of grade 3–4 hematological toxicities in the IC group.

Methods

• 687 patients with stage T3N0-1 NPC treated with intensity-modulated radiation therapy (IMRT) plus concurrent chemotherapy (CC) with or without induction chemotherapy (IC), were examined.
• 237 pairs of patients from two cohorts were selected by propensity score matching (PSM) method.
• The Kaplan–Meier method, log-rank test, and Cox regression analysis were used to appraise overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS).

Results

• There were no significant survival differences between IC plus CC and CC cohorts with similar 4-year OS (91.7% vs 92.6%, P=0.794), LRFS, (92.7% vs 96.8%, P=0.138), DMFS (93.5% vs 94.3%, P=0.582), and PFS (87.5% vs 91.1%, P=0.223).
• As compared to higher EBV DNA (≥4,000 copies/mL), lower Epstein–Barr virus deoxyribonucleic acid (EBV DNA; <4,000 copies/mL) significantly improved 4-year DMFS (95.5% vs 91.6%, P=0.044).
• In a multivariate analysis, no factors were associated with 4-year OS, LRFS, DMFS, and PFS.
• It was noted that IC plus CC group experienced higher rates of grade 3–4 leucopenia (P<0.001) and neutropenia (P<0.001).