Long-term results of locoregionally advanced nasopharyngeal carcinoma treated with cisplatin and 5-fluorouracil induction chemotherapy with or without docetaxel in young and middle aged adults.

Abstract

Purpose: This study aims to evaluate the efficacy and toxicity of the two induction chemotherapy (IC) regimens (TPF: docetaxel, cisplatin and 5-fluorouracil, and PF: cisplatin and 5-fluorouracil) combined with radiotherapy in young and middle aged patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).

Methods: A retrospective analysis was conducted on 329 cases with stage III-IVA nasopharyngeal carcinoma from September 2005 to February 2017. Of the 329 cases, 253 cases underwent TPF (docetaxel: 60 mg/m² on day 1, cisplatin: 25 mg/m² on days 1-3, 5-fluorouracil: 500 mg/m² on days 1-5, intravenous 120-h infusion), while 76 cases received the PF regimen (cisplatin: 25 mg/m² on days 1-3, 5-fluorouracil: 500 mg/m² on days 1-5, intravenous 120-h infusion) every 3 weeks. Radiotherapy was administered after IC with or without concurrent chemotherapy. The survival rates were assessed by Kaplan-Meier analysis, and the survival curves were compared using a log‑rank test.

Results: The 5-year and 8-year overall survival (OS) rates of the PF group and TPF group were 80.1% and 72.1%, 87.3% and 78.4% respectively (p = 0.405). There were no statistical differences in regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates between PF and TPF groups(p = 0.585 and 0.500, respectively).The 5-year and 8-year estimated local recurrence free survival (LRFS) rates for patients in PF and TPF group were 91.1% and 78.0%, 96.2% and 93.7%, respectively (p = 0.026). Moreover, The OS, LRFS, RRFS and DMFS rates were comparable between the non CCRT or CCRT subgroup (p = 0.542, 0.319, 0.070, 0.986, respectively). Compared with PF group, the TPF group significantly increased the occurrence of grade 3 or 4 neutropenia and leukopenia (p < 0.001).

Conclusion: PF and TPF followed by radiotherapy with or without concurrent chemotherapy performed encouraging anti-tumor effects in LA-NPC, there was no statistical significance in 5-year and 8-year OS, RRFS, and DMFS rates between two chemotherapy regimens. Compared with PF, TPF induction chemotherapy achieved more satisfactory LRFS rate in LA-NPC with acceptable toxicity.