title: Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in nasopharyngeal carcinoma patients with cervical nodal necrosis.
abstract: The effectiveness of neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) compared with CCRT alone in nasopharyngeal carcinoma (NPC) patients who presented with cervical nodal necrosis (CNN) is unknown. A total of 792 patients with stage T1-4N1-3M0 NPC and presented with CNN based on magnetic resonance imaging were retrospectively reviewed. Propensity score matching method was used to balance treatment arms for baseline characteristics. Eventually, 508 patients were propensity-matched on a 1:1 basis to create two groups (NACT + CCRT and CCRT groups). Survival rates were calculated by Kaplan-Meier method and differences were compared by using the log-rank test. The 5-year disease specific survival, disease-free survival and distant metastasis-free survival were significantly higher in NACT + CCRT group relative to the matched CCRT group (82.1% vs. 72.5%, P = 0.021; 70.3% vs. 54.1%, P < 0.001; 81.9% vs. 67.3%, P < 0.001, respectively). Although the rates of grade 3-4 leucopenia and mucositis were higher in NACT + CCRT group than CCRT group, compliance with the combined treatment was good and no significant difference was observed between two groups. NACT followed by CCRT was relatively safe and could achieve better survival than CCRT alone in NPC patients with CNN by reducing the risk of death, tumor progression and distant metastasis.
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Lan
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Chen
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Imaging Diagnosis and Interventional Center, Guangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Tian
authors.affiliation: Chengdu Military General Hospital, Department of Radiation Diagnosis and Interventional Center, Chengdu, China.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Duan
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Han
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Junfang
authors.initials: J
authors.lastname: Liao
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Meiling
authors.initials: M
authors.lastname: Deng
authors.affiliation: Mayo Clinic, Department of Radiation Oncology, Scottsdale, Arizona.
authors.forename: Terence T
authors.initials: TT
authors.lastname: Sio
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, King Bangkok, Thailand.
authors.forename: Anussara
authors.initials: A
authors.lastname: Prayongrat
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Imaging Diagnosis and Interventional Center, Guangzhou, China.
authors.forename: Lie
authors.initials: L
authors.lastname: Zheng
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Shaoxiong
authors.initials: S
authors.lastname: Wu
authors.affiliation: State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Guangzhou, China.
authors.forename: Taixiang
authors.initials: T
authors.lastname: Lu
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007970:Leukopenia / Q000209:etiology / Q000401:mortality / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology / Q000401:mortality / Q000473:pathology; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009336:Necrosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D009367:Neoplasm Staging; D010349:Patient Compliance; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents