NACT + IMRT versus NACT + IMRT + CCRT in locoregionally advanced NPC patients: a retrospective study

Xialin Chen,1,2 Xiang Zhu,3 Jianfang Wang,1,2 Jianjiang Liu,1,2 Rong Ji4 1Department of Oncology, Shaoxing People’s Hospital, Shaoxing, Zhejiang 312000, China; 2Department of Oncology, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang 312000, China; 3Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; 4Department of Radiation Oncology, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, China Purpose: The outcomes and safety profiles of neoadjuvant chemotherapy (NACT) + intensity modulated radiotherapy (IMRT) or NACT + IMRT + concurrent chemoradiotherapy (CCRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) patients were retrospectively analyzed.Patients and methods: Between 2010 and 2014, 125 patients with stage III–IVb NPC, who were treated with IMRT (36, 28.8%) or IMRT + CCRT (89, 71.2%) following NACT, participated in the research. There were grade 3–4 toxicities during NACT or radiotherapy (RT) in NACT + IMRT group and NACT + IMRT + CCRT group.Results: MRI within 3 months demonstrated that no patient suffered with progressive disease, 116 patients (92.8%) achieved a response rate (RR) with the complete response (CR) rate of 70.4% (88/125) and partial response (PR) rate of 22.4% (28/125), and nine patients (7.2%) showed stable disease (SD) at the primary site and metastatic nodes. Compared with NACT + IMRT group, patients in NACT + IMRT + CCRT group did not show significantly better RR (93.3% vs 91.7%, P=1.00), CR rate (71.9% vs 66.7%, P=0.67), or PR rate (21.4% vs 25%, P=0.81). There was no significant difference in overall survival (OS, P=0.114), local relapse-free survival (LRFS, P=0.124), distant metastasis-free survival (DMFS, P=0.668) or progression-free survival (PFS, P=0.475) between NACT + IMRT group and NACT + IMRT + CCRT group. T classification (P=0.042) and N classification (P=0.021) were independent prognostic factors for DMFS.Conclusion: To sum up, no significant difference was observed in combined RR, CR rate, LRFS, DMFS, PFS, or OS between the two groups. Keywords: advanced nasopharyngeal carcinoma, intensity modulated radiotherapy, concurrent chemoradiotherapy, neoadjuvant chemotherap