Observation of efficacy of paclitaxel with concurrent radiotherapy in the treatment for nasopharyngeal carcinoma patients with liver metastasis

Abstract

Objective To investigate the efficacy, prognosis and safety of weekly paclitaxel with concurrent radiotherapy in nasopharyngeal carcinoma (NPC) patients with multiple liver metastases. Methods A total of 64 NPC patients with multiple liver metastases in First Affiliated Hospital of Hainan Medical University between January 2016 and January 2018 were recruited and randomly divided into experimental group (n=32) and control group (n=32) by the method of random number table. The patients in the two groups were given palliative radiotherapy with a median dose of 30 Gy. The experimental group used weekly paclitaxel (40 mg/m2) concurrent chemotherapy, cisplatin (40 mg/m2) in the control group. Paclitaxel and cisplatin were used weekly until the end of radiotherapy. The clinical efficacy and adverse effects between the two groups were compared. Results During the follow-up, 1 patient was lost to follow-up in the experimental group, complete remission (CR) in 6 cases (19.4%), partial remission (PR) in 9 cases (29.0%), stable disease (SD) in 7 cases (22.6%) and progressive disease (PD) in 9 cases (29.0%); 2 patients were lost to follow-up in the control group, CR in 4 cases (13.4%), PR in 10 cases (33.3%), SD in 9 cases (30.0%) and PD in 7 cases (23.3%). There was no significant difference between the two groups (Z=-0.060, P=0.952). The effective rates of the experimental group and the control group were 48.4% (15/31) and 46.7% (14/30) respectively, and the difference was not statistically significant (χ2=0.018, P=0.893); the tumor control rates were 71.0% (22/31) and 76.7% (23/30), with no statistically significant difference (χ2=0.256, P=0.613). The median survival time of the experimental group and the control group were 9.4 months and 8.9 months respectively, and the 1-year survival rates were 14.5% and 10.0%, with no significant difference (χ2=1.136, P=0.286). Among the adverse effects, the incidence rates of allergic reaction, neurotoxicity and cardiovascular toxicity in the experimental group were higher than those in the control group [18.8% (6/32) vs. 3.1% (1/32), 28.1% (9/32) vs. 15.6% (5/32), 31.3% (10/32) vs. 15.6% (5/32)], with no significant differences (χ2=2.566, P=0.109; χ2=1.463, P=0.226; χ2=2.177, P=0.140). The incidence rates of granulocyte decline, platelet decline, red blood cell decline, and impaired liver and kidney function in the experimental group were lower than those in the control group [56.3% (18/32) vs. 68.8% (22/32), 12.5% (4/32) vs. 21.9% (7/32), 15.6% (5/32) vs. 25.0% (8/32), 21.9% (7/32) vs. 28.1% (9/32)], with no significant differences (χ2=1.067, P=0.302; χ2=0.988, P=0.320; χ2=0.868, P=0.351; χ2=0.333, P=0.564). The incidence rates of nausea and vomiting was lower than that in the control group [(40.6% (13/32) vs. 78.1% (25/32)], with a significant difference (χ2=9.328, P=0.002). Conclusion Weekly paclitaxel with concurrent radiotherapy has equivalent efficacy to cisplatin and the adverse effects can be tolerated. Key words: Nasopharyngeal neoplasms; Neoplasm metastasis; Radiotherapy; Paclitaxel