Neoadjuvant chemotherapy and prognostic subgroups defined by survival benefit in patients with locoregionally advanced nasopharyngeal carcinoma


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Messaoud Ayad1, Kahina Rabahi1, Kada Boualga1
1Centre Anti-Cancer, Blida, Algeria

Background

To evaluate the contribution of neoadjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma and to identify the prognostic subgroups that could benefit the most fromneoadjuvant chemotherapy.

Method

From 2004 through 2009, 176 patients with stage II to IVb NPC were treated by radiotherapy alone (RT; n: 80) or chemoradiotherapy (RT/CT; n: 96). All patients received 68,4-70 Gy to the nasopharynx. Neoadjuvant chemotherapy consisted of 2-3 cycles of cisplatin and 5-fluorouracil, or cisplatin and docetaxel every 3 weeks. Both groups were well-matched for prognostic factors except cancer stage, with more advanced NPC in RT/CT.

Results

With a mean follow-up of 34.5 months, the 3-year actuarial rates of, disease-free survival (DFS), metastasis-free survival, relapse-free survival and overall survival (OS) for RT/CT and RT alone groups were, 80.2% v 58.7% (Log-rank P: 0.024), 86.4% v 71.4% (Log-rank P: 0.029) , 94.4% v 79.8% (Log-rank P: 0.114) and 84.3% v 76.3% (Log-rank P:0.132), respectively. Using the Cox model adjusted for prognostic factors, improvement in OS on RT/CT was significant (P: 0.049). Stratification analysis showed that DFS improvement was pronounced in the following prognostic subgroups: stage IV, T3/T4 stage, N2/N3 stage, non-keratinizing carcinoma, youngers, males, smokers, drinkers and patients without family history of cancer.

Conclusion

Neoadjuvant chemotherapy improves DFS, OS and MFS for locoregionally advanced NPC, and DFSimprovement was pronounced in some prognostic subgroups. Such work could be helpful to guide effectivetherapy of individuation.