Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus neoadjuvant chemotherapy plus concurrent chemoradiotherapy for ascending or descending types of nasopharyngeal carcinoma: A retrospective study
| Autor: | Peichan Zheng, Xuewen Wang, Yan Zhang, Linbin Lu, Xiong Chen, Shuyi Chen, Yaying Chen, Yihong Lin, Shaoqin Lin, Qin Lin, Hong Chen |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment otorhinolaryngologic diseases medicine Humans Stage (cooking) Neoplasm Staging Retrospective Studies Chemotherapy Nasopharyngeal Carcinoma business.industry Age Factors Retrospective cohort study Nasopharyngeal Neoplasms Chemoradiotherapy Middle Aged medicine.disease Combined Modality Therapy Confidence interval Neoadjuvant Therapy Concurrent chemoradiotherapy Radiation therapy Survival Rate Treatment Outcome Otorhinolaryngology Nasopharyngeal carcinoma Female Radiology Intensity modulated radiotherapy Radiotherapy Intensity-Modulated business |
| Zdroj: | American journal of otolaryngology. 43(1) |
| ISSN: | 1532-818X |
| Popis: | This study aimed to compare the efficacy between neoadjuvant chemotherapy (NACT) plus intensity-modulated radiotherapy (IMRT) and NACT plus concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC).Data from 603 patients with ascending (T4 and N0-1) or descending (T1-2N3) NPC who were treated at Sun Yat-sen University Cancer Center between October 2009 and February 2012 were retrospectively analyzed. These patients were divided into two groups: NACT+IMRT (n = 302) and NACT+CCRT (n = 301). The primary endpoint was overall survival (OS), which was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards model, and landmark analysis.In univariate analysis, there was no significant difference in 5-year OS between the NACT+IMRT and NACT+CCRT groups (hazard ration [HR]: 0.69; 95% confidence interval [CI]: 0.47-1.01; P = 0.057). However, after adjustment for age (45 years, ≥45 years), gender, histological stage (I/II, III), T stage (1/2, 3, 4), and N stage (0/1, 2/3), NACT+IMRT was more effective in improving OS, with a 33% decrease in the risk of death than NACT+CCRT (HR: 0.67; 95%CI: 0.45-0.99). Furthermore, landmark analysis indicated that patients in the NACT+IMRT group had higher OS rates within 24 months (HR: 1.83; 95%CI: 1.00-3.34), whereas those treated with NACT+CCRT had higher OS rates after 24 months (HR, 0.47; 95% CI, 0.29-0.77). We also found significant survival benefits of NACT+IMRT regimen in patients younger than 45 years old (HR: 0.27; 95%CI: 0.14-0.49), and in those at stage T3 (HR: 0.50; 95%CI: 0.27-0.93) and stage N2/3 (HR: 0.52; 95%CI: 0.32-0.83).Patients with ascending or descending NPC who are treated with NACT+IMRT may have better long-term survival outcomes than those treated with NACT+CCRT, especially the patients younger than 45 years old or in stage T3/N2/N3. Additionally, NACT+IMRT may be a better option than NACT+CCRT in patients within the first 24 months. |
| Databáze: | OpenAIRE |
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