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Concurrent CRT no better than neoadjuvant chemotherapy for nasopharyngeal carcinoma
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Limited advantage was noted for treatment with concurrent chemoradiotherapy plus adjuvant chemotherapy vs. neoadjuvant chemotherapy plus radiotherapy plus adjuvant chemotherapy in patients with nasopharyngeal carcinoma, according to Tingting Xu, department of radiation oncology, Fudan University Cancer Hospital in Shanghai, China.
From September 2004 to April 2007, researchers randomly assigned 170 patients to a neoadjuvant chemotherapy plus radiotherapy plus adjuvant chemotherapy group and 168 patients to the concurrent chemotherapy group plus adjuvant chemotherapy group.
There was no significant difference between groups for three-year disease-free survival. The three-year metastasis-free survival rates were 82.2% for neoadjuvant chemotherapy vs. 91.1% for concurrent chemotherapy (P=.04). The three-year relapse-free survival rate was 92% for neoadjuvant chemotherapy vs. 83.1% for concurrent chemotherapy (P=.16). Finally, in the group assigned neoadjuvant chemotherapy, OS was 95.7% vs. 93.1% in the group assigned concurrent chemotherapy.
In a subgroup analysis of T3-4N0-1 patients, three-year metastasis-free-survival was 72.6% with neoadjuvant chemotherapy vs. 93.8% with concurrent chemotherapy (95% CI, 1.16–7.47). This result was not achieved in T1-4N2-3 patients.
The rates for grade-3 and grade-4 mucositis (P=.023) and vomiting (P=.00) were higher in the concurrent chemotherapy group.
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- Xu T. #8.