Gemcitabine/cisplatin induction chemotherapy before concurrent chemotherapy and intensity-modulated radiotherapy improves outcomes for locoregionally advanced nasopharyngeal carcinoma

// Wang Fangzheng 1, 2, 3, * , Sun Quanquan 1, 2 , Jiang Chuner 4, * , Wang Lei 1, 2 , Yan Fengqin 1, 2 , Ye Zhimin 1, 2 , Liu Tongxin 1, 2 , Xu Min 5 , Wu Peng 6 , Jiang Haitao 7 , Rihito Aizawa 8 , Masoto Sakamoto 3 , Wang Yuezhen 1, 2 and Fu Zhenfu 1, 2 1 Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China 2 Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People’s Republic of China 3 Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501, Japan 4 Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China 5 Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China 6 Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China 7 Department of Radiology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People’s Republic of China 8 Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan * These authors contributed equally to this work Correspondence to: Wang Fangzheng, email: wangfz76@126.com Keywords: nasopharyngeal carcinoma, induction chemotherapy, intensity-modulated radiotherapy, concurrent chemotherapy, toxicity Received: March 20, 2017      Accepted: May 14, 2017      Published: May 27, 2017 ABSTRACT Addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CC) is an encouraging first-line treatment strategy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC). We evaluated the clinical efficacy and toxicity of addition of gemcitabine plus cisplatin (GP) IC to intensity-modulated radiotherapy (IMRT) and CC for patients with locoregionally advanced NPC. At a median follow-up duration of 48 months (10–59 months), 4-year local relapse-free survival (LRFS) was 86.9%, regional relapse-free survival (RRFS) was 90.6%, distant metastasis-free survival (DMFS) was 79.8%, progression-free survival (PFS) was 77.0%, and overall survival (OS) was 81.9%. Univariate analysis revealed that T stage, N stage, clinical stage, and CC correlated with OS, while N stage and clinical stage correlated with PFS. In multivariate analysis, T4 was a prognostic indicator of poor OS and PFS, and N3 was a prognostic indicator of poor OS. Having received ≥ 2 cycles of IC was prognostic of better RRFS. During IC, grade 3–4 thrombocytopenia occurred in 10 patients, and grade 3–4 leukocytopenia was observed in 16 patients. Two patients developed mild liver dysfunction. These findings indicate that GP-based IC followed by CC has promising efficacy with acceptable toxicities.