Omission of Chemotherapy in Early Stage Nasopharyngeal Carcinoma Treated with IMRT: A Paired Cohort Study

The objective of this study was to evaluate the necessity of concurrent chemotherapy in T1-2N1 nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT). The retrospective analysis was conducted using the paired comparison method. We matched cases to controls using the greedy matching algorithm with 1:1 control to case ratio. Controls were matched to cases by factors including age, gender, T stage, and duration of RT. The control group included patients received IMRT alone. In another group, concurrent chemotherapy (DDP 40 mg/m(2)/w) was administrated to each paired patient. From Jan 2009 to Dec 2011, a total of 86 well-balanced T1-2N1 (2002 UICC staging system) NPC patients were retrospectively analyzed. Half of them (43 patients) received radical IMRT alone and another 43 received concurrent chemotherapy with IMRT (CCRT). Median follow-up is 37.4 months (4.8–66.2 months). All patients received a radiation dose of 66Gy/30Fx. In the CCRT group, all patients received a cumulative dose of ≥200 mg/m(2). The differences of 3-year overall survival (OS), 3-year progression-free survival (PFS), 3-year relapse-free survival (RFS), and 3-year metastasis-free survival (MFS) between 2 groups were not significant (P > 0.05). The most frequently increased toxicities related to chemotherapy were mild to moderate leukopenia (P = 0.003) and mild anemia (P = 0.008). Omission of weekly cisplatin chemotherapy resulted in comparable survival outcomes to CCRT in IMRT populations. More data from future randomized trials are warranted to further confirm it.