Clinical efficacy of adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

To evaluate the clinical efficacy of the concurrent chemoradiotherapy (CCRT) combined adjuvant chemotherapy (AC) for locally advanced nasopharyngeal carcinoma (NPC).

From April 2011 to January 2019, 318 patients with locally advanced NPC were collected from radiotherapy center of the Second Affiliated Hospital of Army Medical University. According to the results of CCRT, the patients were divided into the adjuvant group and the no-adjuvant group to comparatively analyze the survival outcome and adverse reaction of those patients received adjuvant chemotherapy. Stratification analysis was used to analyze the survival difference of different therapy plans (CCRT, CCRT+AC, IC+CCRT and IC+CCRT+AC) among 318 patients. The survival difference of 99 pairs of patients in the subgroup of clinical parameters was analyzed after the patients in the adjuvant group were paired with the patients in the no-adjuvant group.

Compared with CCRT, CCRT combined with adjuvant chemotherapy could increase the overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and recurrence-free survival (RFS); Compared with IC plus CCRT (IC+CCRT), IC+CCRT+AC showed a decreasing trend in OS, PFS, DMFS and RFS. According to the results of stratification analysis, for EBV positive, N₃ stage and IVA stage patients, adjuvant chemotherapy had a tendency to increase OS, PFS, DMFS and RFS, and increase the RFS for the T₄ stage patients. There was no difference in acute radiation mucositis, acute radiation pharyngitis and esophagitis between the two groups. The adjuvant group had higher incidence rate than the non-adjuvant group in ≥2 grade of myelosuppression (68% vs 55%, P=0.020).

Adjuvant chemotherapy after concurrent chemoradiotherapy cannot significantly increase the survival benefit for patients with locally advanced NPC; For EBV positive, stage N₃ and stage ⅣA patients, there is a positive trend in OS, PFS, DMFS and RFS, and for stage T₄ patients, they also obtain benefit in PFS.