Neoadjuvant Chemotherapy of Three Cycles or More Improve Survival ofPatients with N2-3 Nasopharyngeal Carcinoma

Background: Concurrent chemo-radiation is now the standard treatment of nasopharyngeal carcinoma. However, distant metastases remain the major cause of death. The purpose of this study was to evaluate the impact of neoadjuvant chemotherapy of 3 cycles or more on survival of patients with N2-3 nasopharyngeal carcinoma. Methods: In this study, a total of 553 consecutive patients with non-metastatic N2-3 nasopharyngeal carcinoma were recruited. 102 patients with neoadjuvant chemotherapy of 3 cycles or more (NACT≥3 group) were matched 1:2:1 to 204 patients with neoadjuvant chemotherapy of 2 cycles (NACT=2 group) and 102 patients without neoadjuvant chemotherapy (NACT=0 group), according to age, N stage, histological subtype, neoadjuvant chemotherapy regimen. Five candidate variables (sex, T stage, concurrent chemotherapy, intensity-modulated radiation therapy and cycle number of neoadjuvant chemotherapy) were analyzed for association with survival. Results: After matching, 5-year overall survival, 5-year disease-free survival, 5-year local-recurrence-free survival and 5-year distant-metastasis-free survival of NACT≥3 group were better than those of NACT=2 group and those of NACT=0 group. In multivariate analysis, sex, T stage and cycle number of neoadjuvant chemotherapy maintained statistical significance on 5-year overall survival (P values were 0.029, <0.001 and <0.001), 5-year disease-free survival (P values were 0.020, <0.001 and 0.002), 5-year local-recurrence-free survival (P values were 0.048, 0.001 and 0.002) and 5-year distant-metastasis-free survival (P values were 0.017, <0.001 and <0.001). Conclusion: For N2-3 nasopharyngeal carcinoma, neoadjuvant chemotherapy of 3 cycles or more appeared to be an independent factor associated with improvement of survival.