Adjuvant chemotherapy in nasopharyngeal carcinoma.
The Lancet. Oncology(2023)
摘要
The value of adjuvant chemotherapy after definitive radiotherapy in locoregionally advanced nasopharyngeal carcinoma has been debated since the landmark publication of the Intergroup-0099 trial. 1 Al-Sarraf M LeBlanc M Giri PG et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998; 16: 1310-1317 Crossref PubMed Google Scholar The differing views occur for two reasons: (1) early chemoradiotherapy trials in the 2000s investigated various platinum-based regimens of concurrent chemoradiotherapy alone or in combination with adjuvant chemotherapy, with both strategies showing survival benefits over radiotherapy alone; and (2) it was generally observed that platinum doublet adjuvant chemotherapy after concurrent chemoradiotherapy was poorly tolerated. 2 Chua MLK Wee JTS Hui EP Chan ATC Nasopharyngeal carcinoma. Lancet. 2016; 387: 1012-1024 Summary Full Text Full Text PDF PubMed Scopus (934) Google Scholar The resistance towards recommending adjuvant chemotherapy to patients in the clinic was compounded after a phase 3 trial in China showed that adjuvant cisplatin–fluorouracil chemotherapy did not significantly improve failure-free survival after concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma compared with concurrent chemoradiotherapy alone. 3 Chen L Hu CS Chen XZ et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012; 13: 163-171 Summary Full Text Full Text PDF PubMed Scopus (432) Google Scholar Concurrent chemoradiotherapy followed by adjuvant cisplatin–gemcitabine versus cisplatin–fluorouracil chemotherapy for N2–3 nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trialOur findings suggest that concurrent adjuvant cisplatin–gemcitabine could be used as an adjuvant therapy in the treatment of patients with N2–3 nasopharyngeal carcinoma, although long-term follow-up is required to confirm the optimal therapeutic ratio. Full-Text PDF
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