title: A phase III randomized study comparing neoadjuvant chemotherapy with concurrent chemotherapy combined with radiotherapy for locoregionally advanced nasopharyngeal carcinoma: updated long-term survival outcomes.
abstract: OBJECTIVE
  To determine whether concurrent chemoradiotherapy (CCRT) can improve survival rates compared to the neoadjuvant chemotherapy (NACT) regimen in locoregionally advanced nasopharyngeal carcinoma (NPC) patients.
  
  
  METHODS
  A total of 338 patients with biopsy-proven NPC were randomly assigned to receive NACT followed by radical radiotherapy (RT) then adjuvant chemotherapy (AC) or CCRT followed by AC.
  
  
  RESULTS
  With a median follow-up of 60 months, the 5-year overall survival (OS) rate did not differ significantly between two groups (75.5% vs 79.4% in CCRT and NACT group respectively, P=0.47, HR=0.84, 95%CI 0.53-1.33). Metastasis-free survival (MFS) rate was significantly improved by the CCRT (79.0% vs 86.9%, P=0.05, HR=0.59, 95%CI 0.35-1.00). Subgroup analysis indicated that the benefit of CCRT was derived from N0/N1 tumors (78.0% vs 93.5%, P=0.05, HR=0.35, 95%CI 0.12-0.99). Higher rates of mucositis (52.4% vs. 35.9% P=0.02) and vomiting (13.7% vs. 4.7% P=0.00) were noted in the CCRT arm. Late toxicities were similar in two groups.
  
  
  CONCLUSIONS
  The updated results demonstrated no significant survival benefit of CCRT over NACT in patients with locoregionally advanced NPC. CCRT only showed significant MFS efficacy in T3-4N0-1 populations.
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, China.
authors: Tingting
authors: T
authors: Xu
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, China.
authors: Guopei
authors: G
authors: Zhu
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, China.
authors: Xiayun
authors: X
authors: He
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, China.
authors: Hongmei
authors: H
authors: Ying
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Centre, China. Electronic address: hucsu62@yahoo.com.
authors: Chaosu
authors: C
authors: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D059248:Chemoradiotherapy / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000628:therapy; D020360:Neoadjuvant Therapy / Q000379:methods; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chemoradiotherapy; Concurrent chemotherapy; Nasopharyngeal carcinoma; Neoadjuvant chemotherapy; Randomized study