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Cancer Research and Treatment > Epub ahead of print
doi: https://doi.org/10.4143/crt.2022.1651    [Epub ahead of print]
Individualized Concurrent Chemotherapy for Patients with Stage III-IVa Nasopharyngeal Carcinoma Receiving Neoadjuvant Chemotherapy Combined with Definitive Intensity-Modulated Radiotherapy
Pengjie Ji1 , Qiongjiao Lu1 , Xiaoqiang Chen2, Yuebing Chen1, Xiane Peng3, Zhiwei Chen4,5, Cheng Lin1, Shaojun Lin1,6, Jingfeng Zong1
1Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
2Department of Otolaryngology, Fujian Medical University Union Hospital, Fujian, China
3Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fujian, China
4Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fujian, China
5Fuzhou Center for Disease Control and Prevention, Fuzhou, Fujian, China
6Fujian Key Laboratory of Translational Cancer Medicine, Fujian, China
Correspondence  Jingfeng Zong ,Tel: 86-13365910013, Fax: 86-591-83928767, Email: zongjingfeng@fjmu.edu.cn
Received: December 23, 2022;  Accepted: May 10, 2023.  Published online: May 11, 2023.
*Pengjie Ji and Qiongjiao Lu contributed equally to this work.
This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT).
Materials and Methods
A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test.
There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT.
Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.
Key words: Nasopharyngeal carcinoma, Epstein-Barr virus DNA, Individualized treatment, Chemoradiotherapy
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