Induction versus Adjuvant Chemotherapy Combined with Concurrent Chemoradiation: What Is Beneficial in Locally Advanced Nasopharyngeal Carcinoma-A 5-Year Comparative Study at a Tertiary Care Center in North India.

Abstract

Background: In locally advanced nasopharyngeal cancer (LANPC), concurrent chemoradiotherapy (CCRT) has been established as the current standard of care, but recently, the addition of induction chemotherapy to CCRT has presented an attractive multidisciplinary approach.

Objectives: The aim of the study was to explore the clinical outcome of induction chemotherapy (IC) followed by CCRT and CCRT followed by adjuvant chemotherapy (AC) in LANPC.

Material and methods: In this propensity score-matched retrospective cohort study, we enrolled LANPC patients from October 2016 to June 2022. Study variables were evenly distributed by propensity score matching. Independent prognostic factors were identified using Cox regression analysis, and the outcome between the two chemotherapy treatment combinations was compared for patients in different subgroups.

Result: A total of 80 patients were included in the study. Survival outcomes indicated that the IC followed by CCRT group (IC + CCRT) achieved a higher 5-year overall survival (OS; 90 vs. 81%, p  = 0.253), failure-free survival (FFS; 80 vs. 77.50%, p  = 0.17), and distant metastasis-free survival (DMFS; 88 vs. 82.50%, p  = 0.314) compared with the CCRT followed by AC group (CCRT + AC), although it was not statistically significant. The stratified analysis revealed that IC followed by CCRT (IC + CCRT) was associated with significantly improved OS (hazard ratio [HR] = 0.212; 95% confidence interval [CI] = 0.014-3.16; p  = 0.0026) in N2 disease. However, the superiority of CCRT followed by AC (CCRT + AC) was only observed in LRRFS (HR = 0.45; 95% CI = 0.05-0.89; p  = 0.036) for the T4 subgroup.

Conclusion: In patients with LANPC, especially with T3 or N2 disease, IC should be strongly considered followed by CCRT.