title: The Role of Neoadjuvant Chemotherapy in the Treatment of Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Study (KROG 11-06) Using Propensity Score Matching Analysis.
abstract: OBJECTIVE
  We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm).
  
  
  METHODS
  A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed.
  
  
  RESULTS
  After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018).
  
  
  CONCLUSIONS
  This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.
authors.affiliation: Department of Radiation Oncology, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Song
authors.affiliation: Department of Radiation Oncology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hong-Gyun
authors.initials: HG
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Bhum Suk
authors.initials: BS
authors.lastname: Keam
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeong Hun
authors.initials: JH
authors.lastname: Hah
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Ahn
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dongryul
authors.initials: D
authors.lastname: Oh
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jae Myoung
authors.initials: JM
authors.lastname: Noh
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chang Geol
authors.initials: CG
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Keum
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jihye
authors.initials: J
authors.lastname: Cha
authors.affiliation: Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, Seoul, Korea.
authors.forename: Kwan Ho
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Moon
authors.affiliation: Department of Radiation Oncology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ji-Yoon
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Woong-Ki
authors.initials: WK
authors.lastname: Chung
authors.affiliation: Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Young Taek
authors.initials: YT
authors.lastname: Oh
authors.affiliation: Department of Radiation Oncology, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Won Taek
authors.initials: WT
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Moon-June
authors.initials: MJ
authors.lastname: Cho
authors.affiliation: Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
authors.forename: Chul Seung
authors.initials: CS
authors.lastname: Kay
authors.affiliation: Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yeon-Sil
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010349:Patient Compliance / Q000706:statistics & numerical data; D018579:Patient Selection; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chemoradiotherapy; Induction chemotherapy; Nasopharyngeal neoplasms; Radiotherapy; Republic of Korea