Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma A matched-pair multicenter analysis of outcomes

Purpose The benefit of adjuvant chemotherapy (AC) in locoregionally advanced nasopharyngeal carcinoma (NPC) is controversial. This study compared concurrent chemoradiotherapy plus AC (CCRT/AC) with CCRT. Methods Pair-matched analysis based on eight clinicopathological features of 244 patients treated with platinum-based CCRT/AC or CCRT alone was performed. Survival outcomes were assessed using the Kaplan-Meier method and log-rank test. Toxicities and response rates were compared using Fisher's exact test. Results Four-year overall survival, progression-free survival, distant failure-free survival, and locoregional failure-free survival were 72%, 61%, 71%, and 81%, respectively, for the CCRT arm, compared to 74% (hazard ratio, HR 0.89; 95% confidence interval, CI 0.64-1.23; P = 0.474), 62% (HR 0.91, 95% CI 0.68-1.20, P = 0.489), 73% (HR 0.84, 95% CI 0.59-1.18, P = 0.316), and 84% (HR 0.84, 95% CI 0.52-1.24, P = 0.323), respectively, for the CCRT/AC arm. Cox multivariate regression analysis demonstrated AC was not an independent prognostic factor. Overall, there was a higher incidence of grade 3-4 toxicities in the CCRT/AC arm. The most common grade 3-4 adverse events in the CCRT/AC arm were vomiting (27 %), nausea (43%), leukopenia/neutropenia (23%), thrombocytopenia (8.8%), and anemia (6.2%). Conclusion Addition of AC to CCRT increased toxicities but did not improve survival in locoregionally advanced NPC.