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• W2973014228 abstract "Many clinical studies have demonstrated that induction chemotherapy plus concurrent chemoradiotherapy improved the survival of locally advanced nasopharyngeal carcinoma (NPC). 3 cycles of induction chemotherapy was usually designed and conducted in clinical trials. However, it is still unknown about how many cycles of induction chemotherapy is optimal choice for NPC. This study attempted to define the optimal cycles of induction chemotherapy among 2, 3, and 4 cycles basing on real-world clinical practice. Between January 2009 and December 2015, patients with NPC (clinical stage II-IVb) were retrospectively analyzed. Our inclusion criteria were as follows: (1) histologically confirmed NPC; (2) disease classified as clinical stage II-IVb; (3) patients received induction chemotherapy followed by IMRT with or without concurrent chemotherapy; (4) ECOG≤1. The exclusion criteria were as follows: (1) the patient was diagnosed with other concomitant malignant disease, (2) the use of adjuvant chemotherapy. The primary outcome was overall survival (OS). The secondary endpoints included progression-free survival (PFS), locoregional recurrence-free (LRFS), distant metastasis-free survival (DMFS) and toxicities. Chi-square test was used to compare the baseline characteristics and incidence of adverse events. The Kaplan-Meier method was used to calculate the OS, PFS, LRFS, and DMFS. The log-rank test was used to compare the survival curves. Multivariate Cox proportional hazard analysis was performed to identify the independent predictors among various potential prognostic factors. Among 3,048 patients diagnosed as NPC, a total of 673 eligible patients were included. After a median follow-up of 53 months (IQR 38–74), there was insignificant difference between 2 and 3 cycles group in terms of OS [hazard ratios (HR) 0.905, 95% confidence interval (CI) 0.568-1.442, P = 0.725], PFS (HR 0.989, 95% CI 0.682-1.435, P = 0.979), LRFS (HR 1.125 , 95% CI 0.676-1.871, P = 0.621) and DMFS (HR 0.882, 95% CI 0.559-1.391, P = 0.626). Compared with 3 cycles group, 4 cycles group cannot bring survival benefit and significantly increased the risk of death, progression, distant metastasis, and loco-regional relapse (OS: HR 2.223, 95% CI 1.368-3.645, P=0.001; PFS: HR 2.207, 95% CI 1.494-3.261, P < 0.001; DMFS: HR 2.046, 95% CI 1.245-3.362, P = 0.004; LRFS: HR 2.065, 95% CI 1.233-3.459, P = 0.005). In multivariate analysis, cycles of induction chemotherapy and lymph node stage were significant prognostic factors in OS, PFS, and DMFS. Increased rate of adverse effects was observed with increased cycles of induction chemotherapy. Compared to the 3 cycles of induction chemotherapy, 4 cycles lead to poor prognosis. 2 cycles of induction chemotherapy achieved similar survival benefits to the 3 cycles, but with lower rate of adverse events. Thus, 2 or 3 cycles of induction chemotherapy is recommended in clinical practice and future randomized controlled clinical trials." @default.
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• W2973014228 date "2019-09-01" @default.
• W2973014228 modified "2023-09-25" @default.
• W2973014228 title "How Many Cycles of Induction Chemotherapy Is Optimal Choice for Locally Advanced Nasopharyngeal Carcinoma? Data from a Real-World Clinical Practice" @default.
• W2973014228 doi "https://doi.org/10.1016/j.ijrobp.2019.06.1578" @default.
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