Neoadjuvant chemotherapy in local-regionally advanced nasopharyngeal carcinoma: A National Cancer Database analysis

Laryngoscope. 2018 Dec;128(12):2770-2777. doi: 10.1002/lary.27254. Epub 2018 Aug 22.

Abstract

Objectives/hypothesis: To assess patterns of care and outcomes with the use of neoadjuvant chemotherapy followed by definitive radiation in local-regionally advanced nasopharyngeal carcinoma.

Study design: Retrospective database analysis.

Methods: We queried the National Cancer Database for patients with T3-4N2 or T1-4N3 nasopharyngeal carcinoma who received concurrent chemoradiotherapy or neoadjuvant chemotherapy followed by radiation. Overall survival (OS) was analyzed using the Kaplan-Meier method, propensity-score matching, and a Cox proportional hazards model adjusting for demographic and disease-specific prognostic factors.

Results: From 2004 to 2014, a total of 1,731 patients were identified, including 504 patients (27%) who received neoadjuvant chemotherapy. Neoadjuvant chemotherapy was used more frequently in years 2008 to 2010 (34%) and 2011 to 2014 (30%) compared with 2004 to 2007 (22%) (χ2 P = .001). At a median follow-up of 36.6 months, patients had 3-year OS of 66% in the neoadjuvant group compared with 70% in those who received concurrent chemoradiotherapy (log rank P = .29). On subgroup analysis by histology, T stage, and N stage, there remained no differences in OS between the two groups. On multivariable analysis, there was no significant survival difference associated with neoadjuvant chemotherapy (adjusted hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 0.89-1.25, P = .54). In a propensity score-matched population of 1,008 patients (504 with neoadjuvant therapy and 504 without), there was no significant survival difference associated with neoadjuvant chemotherapy (H: 1.13, 95% CI: 0.93-1.38, P = .22).

Conclusions: Neoadjuvant chemotherapy was used in over 25% of patients, and its use is increasing. However, neoadjuvant chemotherapy was not associated with any differences in survival compared to concurrent chemoradiotherapy.

Level of evidence: 4 Laryngoscope, 128:2770-2777, 2018.

Keywords: National Cancer Database; induction chemotherapy; nasopharyngeal carcinoma; neoadjuvant chemotherapy; radiation therapy.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Chemoradiotherapy
  • Chemotherapy, Adjuvant
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma / diagnosis
  • Nasopharyngeal Carcinoma / mortality
  • Nasopharyngeal Carcinoma / therapy*
  • Nasopharyngeal Neoplasms / diagnosis
  • Nasopharyngeal Neoplasms / mortality
  • Nasopharyngeal Neoplasms / therapy*
  • Neoadjuvant Therapy
  • Neoplasm Staging*
  • Registries*
  • Retrospective Studies
  • Survival Rate / trends
  • United States / epidemiology
  • Young Adult

Substances

  • Antineoplastic Agents