IMRT combined with Concurrent chemotherapy plus adjuvant chemotherapy versus IMRT combined with concurrent chemotherapy alone in patients with nasopharyngeal carcinoma

Purpose: To evaluate the efficacy of IMRT combined with concurrent chemotherapy followed by adjuvant chemotherapy compared with IMRT combined with concurrent chemotherapy alone in patients with nasopharyngeal carcinoma. Methods: From January 2007 to December 2014, we collected 797 staged II-IVb [UICC = Union for International Cancer Control criteria (7th edition)] NPC patients for analysis. After 1: 1 matching, we selected 261 cases as the CCRT group, another 261 patients as the CCRT+ AC group. Using Kaplan-Meier to calculate the overall survival (OS), locoregional failure-free survival(LFFS), distant metastasis failure-free survival(DMFS). The log-rank test and Cox-proportional hazards model to evaluate the prognostic factors. Results: After matching, there were 261 patients in each group. In CCRT+ AC group, The 1-, 2-and 3-year os rates were a little higher than in CCRT group(99.6% vs 97.9%, 97.4% vs 96.2%, 93.8% vs 86.9%, P = 0.150). There were no significant difference in 1-, 2-, 3-year OS, LFFS, DMFS between the two groups. In subgroup analysis, a little higher OS rate in CCRT+ AC group for staged III, IV and T4(III: 100% vs 100%, 97.6% vs 95.8%, 94.0% vs 84.0%; IV: 99.1% vs 95.4%, 96.3% vs 95.4%, 90.5% vs 79.4%, P = 0.047; T4: 99.1% vs 95.2%, 97.1% vs 95.2%, 90.9% vs 78.2%, P = 0.055). No significant difference were observed in OS, LFFS, DMFS between the groups. Conclusion: IMRT combined with concurrent chemotherapy followed by adjuvant chemotherapy might improved 1-, 2-, 3-year of OS. Whether or not add adjuvant chemotherapy it had similar LFFS rate and DMFS rate in patients with nasopharyngeal carcinoma. Locally advanced NPC patients (III, IV and T4) might benefit from the adjuvant chemotherapy.