Effects of Different Chemoradiotherapy Regimens on Early Survival Outcomes in Patients with Locally Advanced Nasopharyngeal Carcinoma

  Objective  To compare the early survival outcomes of patients with locally advanced nasopharyngeal carcinoma received EPF (epirubicin, cisplatin and fluorouracil) induced chemotherapy combined with concurrent nimotuzumab with radiotherapy (CNRT) or DPF (docetaxel, cisplatin and fluorouracil) induced chemotherapy combined with concurrent chemoradiotherapy (CCRT).

  Methods  Patients with locally advanced nasopharyngeal carcinoma (stage Ⅲ to ⅣB) from March 2010 to September 2017 were included. The primary endpoint was disease-free survival (DFS). The secondary endpoints were distant metastasis-free survival (DMFS), local recurrence-free survival (LRFS), and overall survival (OS). Propensity score matching was used to balance the differences in clinical characteristics between the two groups. Kaplan-Meier method and log-rank test were used to compare the survival differences between the two groups. Multivariate Cox proportional hazards model was used to identify potential prognostic factors.

  Results  After matching, a total of 153 patients were enrolled, including 51 patients in the EPF combined with CNRT group and 102 patients in the DPF combined with CCRT group. There was no difference in 2-year DFS (82.4% vs. 85.3%, P=0.880), OS (88.2% vs. 96.0%, P=0.410), LRFS (100.0% vs. 92.1%, P=0.278), and DMFS (82.3% vs. 88.2%, P=0.120) between EPF combined with CNRT group and DPF combined with CCRT group. Treatment regimen (EPF combined with CNRT vs. DPF combined with CCRT) was not an independent prognostic factor of DFS (hazard ratio (HR)=0.530, P=0.075). In the subgroup analyses, EPF combined with CNRT could reduce the risk of disease progression in T₃ (HR=0.174, P=0.045), N₁/N₂ (HR=0.432, P=0.036), and male patients (HR=0.437, P=0.044). During concurrent radiotherapy, the incidence of grade 3-4 neutropenia in EPF combined with CNRT was significantly lower than that of DPF combined with CCRT (P=0.007).

  Conclusion  EPF combined with CNRT regimen is similar to DPF combined with CCRT regimen in survival outcomes, but the patients with T₃, N₁/N₂, and male nasopharyngeal carcinoma may benefit from EPF combined with CNRT regimen.