Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

Purpose The benefit of adjuvant chemotherapy (AC) in locoregionally advanced nasopharyngeal carcinoma (NPC) is controversial. This study compared concurrent chemoradiotherapy plus AC (CCRT/AC) with CCRT. Methods Pair-matched analysis based on eight clinicopathological features of 244 patients treated with platinum-based CCRT/AC or CCRT alone was performed. Survival outcomes were assessed using the Kaplan–Meier method and log-rank test. Toxicities and response rates were compared using Fisher’s exact test. Results Four-year overall survival, progression-free survival, distant failure-free survival, and locoregional failure-free survival were 72 %, 61 %, 71 %, and 81 %, respectively, for the CCRT arm, compared to 74 % (hazard ratio, HR 0.89; 95 % confidence interval, CI 0.64–1.23; P = 0.474), 62 % (HR 0.91, 95 % CI 0.68–1.20, P = 0.489), 73 % (HR 0.84, 95 % CI 0.59–1.18, P = 0.316), and 84 % (HR 0.84, 95 % CI 0.52–1.24, P = 0.323), respectively, for the CCRT/AC arm. Cox multivariate regression analysis demonstrated AC was not an independent prognostic factor. Overall, there was a higher incidence of grade 3–4 toxicities in the CCRT/AC arm. The most common grade 3–4 adverse events in the CCRT/AC arm were vomiting (27 %), nausea (43 %), leukopenia/neutropenia (23 %), thrombocytopenia (8.8 %), and anemia (6.2 %). Conclusion Addition of AC to CCRT increased toxicities but did not improve survival in locoregionally advanced NPC.