The Effect of Adding Neoadjuvant Chemotherapy to Concurrent Chemoradiotherapy in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma and Undetectable Pretreatment Epstein-Barr Virus DNA

Ya-Nan Jin; Ji-Jin Yao; Si-Yang Wang; Wang-Jian Zhang; Fan Zhang; Guan-Qun Zhou; Zhi-Bin Cheng; Hao-Yuan Mo; Ying Sun

doi:10.1016/j.tranon.2017.03.007

The Effect of Adding Neoadjuvant Chemotherapy to Concurrent Chemoradiotherapy in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma and Undetectable Pretreatment Epstein-Barr Virus DNA

Transl Oncol. 2017 Aug;10(4):527-534. doi: 10.1016/j.tranon.2017.03.007. Epub 2017 May 29.

Authors

Ya-Nan Jin¹, Ji-Jin Yao², Si-Yang Wang², Wang-Jian Zhang³, Fan Zhang², Guan-Qun Zhou⁴, Zhi-Bin Cheng², Hao-Yuan Mo⁵, Ying Sun⁶

Affiliations

¹ State Key Laboratory of Oncology in South, China; Collaborative Innovation Center of Cancer Medicine; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong 510060, China.
² Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519001, China.
³ Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
⁴ State Key Laboratory of Oncology in South, China; Collaborative Innovation Center of Cancer Medicine; Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
⁵ State Key Laboratory of Oncology in South, China; Collaborative Innovation Center of Cancer Medicine; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong 510060, China. Electronic address: [email protected].
⁶ State Key Laboratory of Oncology in South, China; Collaborative Innovation Center of Cancer Medicine; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P.R. China. Electronic address: [email protected].

Abstract

Purpose: To assess the effect of adding neoadjuvant chemotherapy (NACT) to concurrent chemoradiotherapy (CCRT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and undetectable pretreatment Epstein-Barr virus (pEBV) DNA.

Materials and methods: We enrolled 639 NPC patients with stage II to IVB and undetectable pEBV DNA to receive CCRT with or without NACT. Radiotherapy was 2.0 to 2.27 Gy per fraction with five daily fractions per week for 6 to 7 weeks to the primary tumor and 62 to 70 Gy to the involved neck area. NACT was cisplatin (80-100 mg/m²day 1) and 5-fluorouracil (800-1000 mg/m², 120-hour continuous intravenous infusion) every 3 weeks for two or three cycles. CCRT was cisplatin (80-100 mg/m²day 1) every 3 weeks for three cycles.

Results: For all patients, the 5-year overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) rates were 91.9%, 92.2%, 95.0%, and 86.4%, respectively. There was no significant difference in OS (5-year OS 90.8% [NACT + CCRT group] vs 92.7% [CCRT alone]; hazard ratio [HR] 1.24; P=.486), LRFS (HR 1.13, 95% confidence interval [CI] 0.59-2.14, P=.715), DMFS (HR 0.78, 95% CI 0.34-1.78, P=.554), or PFS (HR 1.21, 95% CI 0.75-1.95, P=.472).

Conclusion: CCRT with or without NACT produced a good treatment outcome in patients with locoregionally advanced NPC and undetectable pEBV DNA, but NACT before CCRT did not significantly improve survival rates.