Long-term results of locoregionally advanced nasopharyngeal carcinoma treated with cisplatin and 5-fluorouracil induction chemotherapy with or without docetaxel in young and middle aged adults

Abstract Purpose This study aims to evaluate the efficacy and toxicity of the two induction chemotherapy (IC) regimens (TPF: docetaxel, cisplatin and 5-fluorouracil, and PF: cisplatin and 5-fluorouracil) combined with radiotherapy in young and middle aged patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Methods A retrospective analysis was conducted on 329 cases with stage III-IVA nasopharyngeal carcinoma from September 2005 to February 2017. Of the 329 cases, 253 cases underwent TPF (docetaxel: 60 mg/m2 on day 1, cisplatin: 25 mg/m2 on days 1–3, 5-fluorouracil: 500 mg/m2 on days 1–5, intravenous 120-h infusion), while 76 cases received the PF regimen (cisplatin: 25 mg/m2 on days 1–3, 5-fluorouracil: 500 mg/m2 on days 1–5, intravenous 120-h infusion) every 3 weeks. Radiotherapy was administered after IC with or without concurrent chemotherapy. The survival rates were assessed by Kaplan–Meier analysis, and the survival curves were compared using a log‑rank test. Results The 5-year and 8-year overall survival (OS) rates of the PF group and TPF group were 80.1% and 72.1%, 87.3% and 78.4% respectively (p = 0.405). There were no statistical differences in regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates between PF and TPF groups(p = 0.585 and 0.500, respectively).The 5-year and 8-year estimated local recurrence free survival (LRFS) rates for patients in PF and TPF group were 91.1% and 78.0%, 96.2% and 93.7%, respectively (p = 0.026). Moreover, The OS, LRFS, RRFS and DMFS rates were comparable between the non CCRT or CCRT subgroup (p = 0.542, 0.319, 0.070, 0.986, respectively). Compared with PF group, the TPF group significantly increased the occurrence of grade 3 or 4 neutropenia and leukopenia (p < 0.001). Conclusion PF and TPF followed by radiotherapy with or without concurrent chemotherapy performed encouraging anti-tumor effects in LA-NPC, there was no statistical significance in 5-year and 8-year OS, RRFS, and DMFS rates between two chemotherapy regimens. Compared with PF, TPF induction chemotherapy achieved more satisfactory LRFS rate in LA-NPC with acceptable toxicity.