title: Matched analysis of induction chemotherapy plus chemoradiotherapy versus induction chemotherapy plus radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a multicenter study.
abstract: BACKGROUND
  The relative efficacy of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) versus IC followed by radiotherapy (RT) alone in locoregionally advanced NPC remains unclear.
  
  
  METHODS
  A total of 877 patients with locally advanced NPC who underwent IC/CCRT or IC/RT at four institutions in China between January 2004 and December 2010 were retrospectively assessed. IC was cisplatin-based combination chemotherapy; concurrent chemotherapy, single agent cisplatin. Two-dimensional conventional radiotherapy (2DCRT) was the radiotherapy technique. All patients were matched in an equal ratio using a pair-matched method. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRRFS) and toxicities were assessed.
  
  
  RESULTS
  Eligible patients were matched (n = 642; 321 patients per arm) based on eight clinicopathological characteristics. Five-year OS, DFS, DMFS, and LRRFS were 76%, 70%, 86%, and 88% for IC/CCRT and 75%, 70%, 90%, and 91% for IC/RT, respectively. There were no statistically significant survival differences between arms (P>0.05), even in subgroup analysis. In multivariate analysis, treatment (IC/CCRT vs. IC/RT) was not an independent prognostic factor for any survival end-point. Grade 3/4 acute gastrointestinal toxicities (vomiting, nausea) and hematological toxicities (leucopenia/neutropenia, thrombocytopenia and anemia) were significantly more common in the IC/CCRT arm than IC/RT arm during RT.
  
  
  CONCLUSIONS
  Overall, IC/CCRT failed to demonstrate any survival advantage but higher acute toxicities over IC/RT in locoregionally advanced NPC.
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, PR China.|Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, PR China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, PR China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Radiation Oncology, 181st Hospital of People's Liberation Army, Guilin, PR China.
authors.forename: Rui-Hua
authors.initials: RH
authors.lastname: Xiong
authors.affiliation: Department of Radiation Oncology, Nan Xishan Hospital, 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, Guilin, PR China.
authors.forename: Qian-Lan
authors.initials: QL
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, PR China.
authors.forename: Xiang-Yun
authors.initials: XY
authors.lastname: Kong
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, PR China.
authors.forename: Rui
authors.initials: R
authors.lastname: Cai
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, PR China.
authors.forename: Qiu-Qiu
authors.initials: QQ
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 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, Guilin, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002945:Cisplatin
keywords: concurrent chemoradiotherapy; induction chemotherapy; nasopharyngeal carcinoma; radiotherapy