title: Prognostic impact of adjuvant chemotherapy in high-risk nasopharyngeal carcinoma patients.
abstract: To investigate the prognostic impact of adjuvant chemotherapy (AdjCT) in patients with high-risk nasopharyngeal carcinoma (NPC).
  
  
  
  A total 403 NPC patients with at least one of the following criteria (1) neck node>6cm; (2) supraclavicular node metastasis; (3) skull base destruction/intracranial invasion plus multiple nodes metastasis; or (4) multiple neck nodes metastasis with one of nodal size>4cm were retrospectively reviewed. All patients finished curative radiotherapy±neoadjuvant/concurrent chemotherapy. Post-radiation AdjCT consisted of tegafur-uracil (two capsules twice daily) for 12months. We analyzed the treatment outcome between patients with (n=154) and without (n=249) AdjCT.
  
  
  
  Baseline patient characteristics at diagnosis (age, gender, pathological type, performance status, T-classification, N-classification, and overall stage) were comparable in both arms. After a median follow-up of 72months for surviving patients, 31.8% (49/154) and 42.2% (105/249) in patients with and without AdjCT developed tumor relapse respectively (P=0.0377). AdjCT improved both overall survival (HR 1.89, 95% CI 1.37-2.61, P=0.0001) and progression-free survival (HR 1.42, 95% CI 1.03-1.96, P=0.0322). There were significant reduction in distant failures (P=0.0016) but not in local (P=0.8587) or regional (P=0.8997) recurrences for patients who received AdjCT.
  
  
  
  AdjCT can reduce distant failure and improve overall survival in high-risk NPC patients after curative radiotherapy±neoadjuvant/concurrent chemotherapy.
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Liu
authors.affiliation: Department of Nursing, Hung Kuang University, Taichung, Taiwan; Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan.
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Wang
authors.affiliation: Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Twu
authors.affiliation: Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Rong-San
authors.initials: RS
authors.lastname: Jiang
authors.affiliation: Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Kai-Li
authors.initials: KL
authors.lastname: Liang
authors.affiliation: Department of Radiation Oncology, Changhua Show Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Ching-Te
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Radiation Oncology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
authors.forename: Po-Ju
authors.initials: PJ
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Jing-Wen
authors.initials: JW
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: He-Yuan
authors.initials: HY
authors.lastname: Hsieh
authors.affiliation: Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: jclin@vghtc.gov.tw.
authors.forename: Jin-Ching
authors.initials: JC
authors.lastname: Lin
mesh_terms: D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy*; D011379:Prognosis; D016019:Survival Analysis
keywords: Adjuvant chemotherapy; Nasopharyngeal carcinoma; Radiotherapy; Tegafur-uracil