The Role of Neoadjuvant Chemotherapy in the Treatment of Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Study (KROG 11-06) Using Propensity Score Matching Analysis

• Published in: Cancer research and treatment 2016, 48(3), , pp.917-927
• Main Authors: Song, Jin Ho, Wu, Hong-Gyun, Keam, Bhum Suk, Hah, Jeong Hun, Ahn, Yong Chan, Oh, Dongryul, Noh, Jae Myoung, Park, Hyo Jung, Lee, Chang Geol, Keum, Ki Chang, Cha, Jihye, Cho, Kwan Ho, Moon, Sung Ho, Kim, Ji-Yoon, Chung, Woong-Ki, Oh, Young Taek, Kim, Won Taek, Cho, Moon-June, Kay, Chul Seung, Kim, Yeon-Sil
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma - mortality; Carcinoma - pathology; Carcinoma - therapy; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Chemoradiotherapy - statistics & numerical data; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms - mortality; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - therapy; Neoadjuvant Therapy - adverse effects; Neoadjuvant Therapy - methods; Neoadjuvant Therapy - statistics & numerical data; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Original; Patient Compliance - statistics & numerical data; Patient Selection; Propensity Score; Retrospective Studies; Survival Analysis; Time Factors; Treatment Outcome; Young Adult; 의약학
• ISSN: 1598-2998; 2005-9256
• DOI: 10.4143/crt.2015.265

We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm). A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed. After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018). This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.