Long term follow-up results and prognosis analysis of TPF regimen chrono-chemotherapy combined with cisplatin concurrent chemoradiotherapy for the treatment of distant nasopharyngeal carcinoma.

Abstract

e18034 Background: To research whether TPF (Docetaxel plus Fluorouracil plus Cisplatin) chrono-chemotherapy combined with cisplatin concurrent chemoradiotherapy can reduce long-term toxicity without affecting the survival of patients with de novo metastatic nasopharyngeal carcinoma (mNPC) compared with conventional chemotherapy combined with cisplatin concurrent chemoradiotherapy. Methods: A retrospective analysis of the clinical data of 121 de novo mNPC patients who treated with TPF chemotherapy at our hospital from January 1, 2012, to December 31, 2018. Among them, 79 patients were treated with chrono-chemotherapy and 42 patients were treated with conventional chemotherapy. The specific chemotherapy regimen for chrono-chemotherapy group:TPF induction chemotherapy for 2-4 cycles, docetaxel: 75mg/m2, ivgtt, d1; Cisplatin: 75mg/m2, civ, d1-5, 60h (10Am—10Pm); 5-Fluorouracil: 750mg/m2/d, civ, administered by intravenous infusion of electronic chemotherapy automatic injection pump d1-5, 60 hours (10 Pm-10 Am), 21 days/cycle. The evaluation of therapeutic efficacy after induction should involve intensity-modulated radiotherapy for at least patients with stable disease, during which concurrent cisplatin chemotherapy is administered. Two cycles of adjuvant chemotherapy were administered 1 month after radiotherapy with the same regimen as induction chemotherapy. The total chemotherapy cycle was 4-6 cycles. The Kaplan-Meier method and log-rank test were used to estimate overall survival (OS) and progression-free survival (PFS), while the COX proportional hazards model was employed for multivariate analysis. Long-term toxic side effects between the two groups were assessed using the chi-square test or Mann-Whitney U test. Propensity score matching was utilized to address confounding factors. Results: At a median follow-up of 104 months, 69.6% of patients died in the chrono-chemotherapy group and 73.8% in the conventional chemotherapy group, and the median OS and PFS in the chrono-chemotherapy group and conventional chemotherapy group were 40 vs 32 months (P=0.636) and 30 vs 19 months, respectively (P=0. 975), there were no statistically significant differences in OS rates and PFS rates at 3, 5, and 7 years between the two groups before and after matching. The incidence of xerostomia, dysphagia, and trismus in the chrono-chemotherapy group matched for timing was significantly lower than that in the conventional chemotherapy group, with a statistically significant difference. (P<0.05). Conclusions: The TPF chrono-chemotherapy combined with cisplatin concurrent chemoradiotherapy reduces the incidence of toxic side effects while ensuring survival, which can benefit patients.