title: Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma : A matched-pair multicenter analysis of outcomes.
abstract: OBJECTIVE
  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 %).
  
  
  CONCLUSIONS
  Addition of AC to CCRT increased toxicities but did not improve survival in locoregionally advanced NPC.
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.|Department of Otorhinolaryngology, Guilin Medical University Affiliated Hospital, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Yi-Yuan
authors.initials: YY
authors.lastname: Dong
authors.affiliation: Department of Otorhinolaryngology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, PR China.
authors.forename: Chun
authors.initials: C
authors.lastname: Xiang
authors.affiliation: Department of Oncology, Affiliated Hospital of Youjiang Medical University for Nationalities, 18 Zhongshan Second Road, 533000, Baise, PR China.
authors.forename: Jian-Xun
authors.initials: JX
authors.lastname: Lu
authors.affiliation: Department of Radiation Oncology, Lingshan People's Hospital, 1 Zhongxiu Road, 535400, Lingshan, PR China.
authors.forename: Yi-Xin
authors.initials: YX
authors.lastname: Su
authors.affiliation: Department of Radiation Oncology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, PR China.
authors.forename: Yu-Fei
authors.initials: YF
authors.lastname: Pan
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Rui
authors.initials: R
authors.lastname: Cai
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Rong-Jun
authors.initials: RJ
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Zhuo-Kai
authors.initials: ZK
authors.lastname: He
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Mei-Lian
authors.initials: ML
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Hui
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Xue
authors.initials: X
authors.lastname: Bai
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Hua-Ying
authors.initials: HY
authors.lastname: Tang
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Yun-Hua
authors.initials: YH
authors.lastname: Shi
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, PR China. weijiang@glmc.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000401:mortality*; D017024:Chemotherapy, Adjuvant / Q000401:mortality*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy*; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Adverse events; China; Radiation oncology; Survival; Toxicity