Abstract
Background: Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high-risk nonendemic patients. Methods: Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group. Results: On MVA, NAC-improved OS among the total cohort (hazard ratio [HR] 0.89, P =.049), particularly among stratified keratinizing histology (HR 0.82, P =.015) and N3 disease (HR 0.73, P =.046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P =.046). Conclusions: NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.
| Original language | English (US) |
|---|---|
| Journal | Head and Neck |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
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Keywords
- chemoradiation
- head and neck cancer
- nasopharyngeal carcinoma
- neoadjuvant chemotherapy
- radiation therapy
ASJC Scopus subject areas
- Otorhinolaryngology
Cite this
Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease. / Han, James E.; Yi, Sun K.; Wang, Steven; Erman, Audrey; Bearelly, Shethal; Sindhu, Simran; Robbins, Jared R.; Bauman, Julie; Hsu, Charles C.
In: Head and Neck, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease
AU - Han, James E.
AU - Yi, Sun K.
AU - Wang, Steven
AU - Erman, Audrey
AU - Bearelly, Shethal
AU - Sindhu, Simran
AU - Robbins, Jared R.
AU - Bauman, Julie
AU - Hsu, Charles C.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high-risk nonendemic patients. Methods: Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group. Results: On MVA, NAC-improved OS among the total cohort (hazard ratio [HR] 0.89, P =.049), particularly among stratified keratinizing histology (HR 0.82, P =.015) and N3 disease (HR 0.73, P =.046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P =.046). Conclusions: NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.
AB - Background: Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high-risk nonendemic patients. Methods: Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group. Results: On MVA, NAC-improved OS among the total cohort (hazard ratio [HR] 0.89, P =.049), particularly among stratified keratinizing histology (HR 0.82, P =.015) and N3 disease (HR 0.73, P =.046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P =.046). Conclusions: NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.
KW - chemoradiation
KW - head and neck cancer
KW - nasopharyngeal carcinoma
KW - neoadjuvant chemotherapy
KW - radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=85073809586&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073809586&partnerID=8YFLogxK
U2 - 10.1002/hed.25955
DO - 10.1002/hed.25955
M3 - Article
C2 - 31520512
AN - SCOPUS:85073809586
JO - Head and Neck
JF - Head and Neck
SN - 1043-3074
ER -