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. 2019 Oct 22;14(1):182.
doi: 10.1186/s13014-019-1387-9.

Maintenance chemotherapy using S-1 following definitive chemoradiotherapy in patients with N3 nasopharyngeal carcinoma

Jingfeng Zong  1 , Hanchuan Xu  1 , Bijuan Chen  1 , Qiaojuan Guo  1 , Yun Xu  1 , Chuanben Chen  1 , Youliang Weng  1 , Wei Zheng  1 , Jianji Pan  1 , Shaojun Lin  2
Affiliations

Maintenance chemotherapy using S-1 following definitive chemoradiotherapy in patients with N3 nasopharyngeal carcinoma

Jingfeng Zong et al. Radiat Oncol. .

Abstract

Background: Patients with N3 stage nasopharyngeal carcinoma (NPC) are at high risk for treatment failure. This study aims to assess the efficacy of maintenance chemotherapy (MC) using S-1 (MC-S1), a novel oral fluoropyrimidine agent, following definitive chemoradiotherapy (CRT) using intensity-modulated radiotherapy (IMRT) in patients with N3 nasopharyngeal carcinoma (N3-NPC).

Methods: A retrospective review was conducted for all N3-NPC treated with CRT with MC (CRT-MC) or without MC (CRT-non-MC) during 2014-2016. Toxicities with MC were recorded. Overall survival (OS), locoregional failure-free survival (LFFS) and distant metastasis free survival (DMFS) were compared between CRT-MC vs. CRT-non-MC cohorts.

Results: A total of 130 N3 patients were identified, of whom 21 (16.2%) were treated with CRT-MC, and 109 (83.8%) with CRT-non-MC. Patient characteristics did not significantly differ between the CRT-MC and CRT-non-MC groups, with the exception of the number of cycles of neoadjuvant chemotherapy. Following IMRT 69 patients achieved a complete response (CR) (CRT-MC: 10; CRT-non-MC: 59), 61 had a partial response (PR) (11 vs. 50), and none maintained stable disease (SD) or developed progression of disease (PD). After a median follow-up of 41 months for surviving patients, a significant differences in OS (76.3% vs. 95.2%, p = 0.046) and DMFS (70.3% vs. 90.5%, p = 0.043) but not LFFS (84.9% vs. 100%, p = 0.091) at 3 years were observed between the CRT-non-MC and CRT-MC groups. Skin hyperpigmentation, leucopenia, fatigue, neutropenia, anorexia and nausea were the common but not severe (grade 1-2) toxicities of MC.

Conclusions: Using MC-S1 in N3-NPC patients following IMRT achieved superior survival to the CRT-non-MC patients. The toxicities of MC-S1 were mild and tolerable. Further clinical trials are required to evaluate the efficacy of MC-S1 in N3-NPC patients.

Keywords: Chemoradiotherapy; Maintenance chemotherapy; N3; Nasopharyngeal carcinoma; S-1.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Treatment schedule. Patients with stage N3 nasopharyngeal carcinoma were treated with NAT followed by IMRT alone or CCRT. AC and/or MC as described for certain patients. NAT = neoadjuvant chemotherapy; CCRT = concurrent chemoradiotherapy; IMRT = Intensity Modulated Radiation Therapy; AC = adjuvant chemotherapy; MC = maintenance chemotherapy
Fig. 2
Fig. 2
Kaplan–Meier estimates of patients treated with chemoradiotherapy with or without oral maintenance chemotherapy (CRT-MC vs CRT-non-MC)
See this image and copyright information in PMC

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