Neoadjuvant or Adjuvant Chemotherapy Plus Concurrent CRT Versus Concurrent CRT Alone in the Treatment of Nasopharyngeal Carcinoma: A Study Based on EBV DNA

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Li-Ting Liu State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Qiu-Yan Chen State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Lin-Quan Tang State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Shan-Shan Guo State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Ling Guo State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Hao-Yuan Mo State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Yang Li State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Qing-Nan Tang State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Xue-Song Sun State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Yu-Jing Liang State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Chong Zhao State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Xiang Guo State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Chao-Nan Qian State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Mu-Sheng Zeng State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,

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Jin-Xin Bei State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,

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Ming-Huang Hong State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Good Clinical Practice Center,

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Jian-Yong Shao State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Molecular Diagnostics, and

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Ying Sun State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China.

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Jun Ma State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China.

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Hai-Qiang Mai State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,
Department of Nasopharyngeal Carcinoma,

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Background: The goal of this study was to explore the value of adding neoadjuvant chemotherapy (NACT) or adjuvant chemotherapy (ACT) to concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC) with different risks of treatment failure. Patients and Methods: A total of 2,263 eligible patients with stage III–IVb NPC treated with CCRT ± NACT or ACT were included in this retrospective study. Distant metastasis–free survival (DMFS), overall survival, and progression-free survival were calculated using the Kaplan-Meier method and differences were compared using the log-rank test. Results: Patients in the low-risk group (stage N0–1 disease and Epstein-Barr virus [EBV] DNA <4,000 copies/mL) who received NACT followed by CCRT achieved significantly better 5-year DMFS than those treated with CCRT alone (96.2% vs 91.3%; P= .008). Multivariate analyses also demonstrated that additional NACT was the only independent prognostic factor for DMFS (hazard ratio, 0.42; 95% CI, 0.22–0.80; P=.009). In both the intermediate-risk group (stage N0–1 disease and EBV DNA ≥4,000 copies/mL and stage N2–3 disease and EBV DNA <4,000 copies/mL) and the high-risk group (stage N2–3 disease and EBV DNA ≥4,000 copies/mL), comparison of NACT or ACT + CCRT versus CCRT alone indicated no significantly better survival for all end points. Conclusions: The addition of NACT to CCRT could reduce distant failure in patients with low risk of treatment failure.

Submitted August 26, 2018; accepted for publication January 7, 2019.

Author contributions: Study concept: Mai. Study design: Liu, Mai. Data acquisition: Liu, Chen, L.Q. Tang. Quality control of data and algorithms: Liu, Chen, L.Q. Tang, Mai. Data analysis and interpretation: Liu. Statistical analysis: Liu, Chen. Manuscript preparation: Liu, Chen, L.Q. Tang, S.S. Guo. Manuscript editing: Liu, Chen, L.Q. Tang, S.S. Guo, L. Guo, Mo. Manuscript review: Liu, Chen, L.Q. Tang, Zhao, X. Guo, Li, Qian, Zeng, Bei, Liang, Q.N. Tang, Hong, Shao, Sun, Ma, Mai.

Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Supported by grants from the National Key R&D Program of China (2016YFC0902003, 2017YFC1309003, 2017YFC0908500), the National Natural Science Foundation of China (81425018, 81672868, 81602371), the Sun Yat-sen University Clinical Research 5010 Program, the Sci-Tech Project Foundation of Guangzhou City (201707020039), the National Key Basic Research Program of China (2013CB910304), the Special Support Plan of Guangdong Province (2014TX01R145), the Sci-Tech Project Foundation of Guangdong Province (2014A020212103), the Health & Medical Collaborative Innovation Project of Guangzhou City (201400000001), the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (2014BAI09B10), the PhD Start-up Fund of Natural Science Foundation of Guangdong Province, China (2016A030310221), the cultivation foundation for the junior teachers in Sun Yat-Sen University (16ykpy28), and the Fundamental Research Funds for the Central Universities.

Correspondence: Hai-Qiang Mai, MD, PhD, Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China. Email: maihq@sysucc.org.cn

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