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Concurrent chemoradiotherapy with or without neoadjuvant chemotherapy in pediatric patients with stage III-IVa nasopharyngeal carcinoma: a real-world propensity score-matched cohort study

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Abstract

Objectives

To compare neoadjuvant chemotherapy (NAC) plus concurrent chemoradiotherapy (CCRT) to CCRT alone in children and adolescents (age ≤ 18 years) with locoregionally advanced nasopharyngeal carcinoma (CA-LANPC, stage III-IVA).

Materials and methods

195 CA-LANPC patients who were treated through CCRT with or without NAC between 2008 and 2018 were enrolled in this study. A matched cohort composed of CCRT patients and NAC-CCRT patients was generated by propensity score matching (PSM) at a 1:2 ratio. Survival outcomes and toxicities were compared between the CCRT group and NAC-CCRT group.

Results

Of the 195 patients, 158 (81%) received NAC plus CCRT, and 37 (19%) received CCRT alone. The NAC-CCRT group had higher EBV DNA levels (≥ 4000 copy/mL), more advanced TNM stage (stage IV disease), and lower incidence of a high radiation dose (> 6600 cGy) than the CCRT group. To avoid bias in treatment selection within retrospectively analysis, 34 patients from the CCRT group were matched with 68 patients from the NAC-CCRT group. In the matched cohort, the 5-year DMFS rate was 94.0% in the NAC-CCRT group versus 82.4% in the CCRT group, with marginal statistical significance (HR = 0.31; 95%CI 0.09–1.10; P = 0.055). During treatment, the accumulate incidence of severe acute toxicities (65.8% vs 45.9%; P = 0.037) in the NAC-CCRT group was higher than the CCRT group. However, the CCRT group had significantly higher accumulate incidence of severe late toxicities (30.3% vs 16.8%; P = 0.041) than the NAC-CCRT group.

Conclusions

Addition of NAC to CCRT tended to improve long-term DMFS in CA-LANPC patients with acceptable toxicity. However, relative randomized clinical trial is still needed in the future.

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Availability of data and materials

Data statement: Key raw data were uploaded onto the Research Data Deposit public platform (RDD), with the approval RDD number of RDDA2022396736.

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Funding

This work was supported by grants from the Natural Science Foundation of Guangdong, China (2021A1515220128; 2020A1515111075), Excellent Young Researchers Program of the 5th Affiliated Hospital of SYSU (WYYXQN-2021015), National Natural Science Foundation of China (82002557), Guangdong Medical Science and Technology Research Fund (C2018063), Science and Technology Program of Zhuhai, China (2220004000192, 202002030070), and Investigator-Initiated Clinical Trial foundation of the 5th Affiliated Hospital of SYSU (YNZZ2021-04).

Author information

Author notes

  1. Ya-Nan Jin, Zhao-Hui Ruan and Wan-Wei Cao have contributed equally to this work.

Authors and Affiliations

  1. VIP Region, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People’s Republic of China

    Ya-Nan Jin, Zhao-Hui Ruan & Liang-Ping Xia

  2. The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, People’s Republic of China

    Ya-Nan Jin, Wei Yao, Xiao-Feng Pei & Ji-Jin Yao

  3. Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519001, Guangdong, People’s Republic of China

    Wan-Wei Cao

  4. Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, 1838 Baiyun Avenue North, Guangzhou, 510515, People’s Republic of China

    Lin Yang

  5. Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People’s Republic of China

    Wang-Jian Zhang

  6. Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, 12144, USA

    Tia Marks

  7. Guangdong Provincial Key Laboratory of Biomedical Imaging, Zhuhai, Guangdong, People’s Republic of China

    Ji-Jin Yao

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  1. Ya-Nan Jin
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Contributions

Study concepts: LPX and JJY. Study design: YNJ, ZHR, WWC. Data acquisition: YNJ and WWC. Quality control of data and algorithms: YNJ, LY, WY and XFP. Data analysis and interpretation: WJZ and TM. Statistical analysis: WJZ. Manuscript preparation: YNJ, ZHR, WWC. Manuscript editing: TM. Manuscript review: All authors.

Corresponding authors

Correspondence to Ji-Jin Yao or Liang-Ping Xia.

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Jin, YN., Ruan, ZH., Cao, WW. et al. Concurrent chemoradiotherapy with or without neoadjuvant chemotherapy in pediatric patients with stage III-IVa nasopharyngeal carcinoma: a real-world propensity score-matched cohort study. J Cancer Res Clin Oncol 149, 11929–11940 (2023). https://doi.org/10.1007/s00432-023-05041-1

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  • DOI: https://doi.org/10.1007/s00432-023-05041-1

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