Comparison of patients with locally advanced nasopharyngeal cancer receiving induction chemotherapy and those receiving concurrent chemoradiotherapy

Introduction and Aim: Nasopharyngeal carcinoma (NPC) is a rare but aggressive malignancy of the head and neck region. The standard treatment for patients with locally advanced disease is concurrent chemoradiotherapy (CCRT). However, in recent years, the impact of induction chemotherapy (IC) on reducing tumor burden before definitive treatment and its effect on survival outcomes has been widely investigated. This study compares the clinical outcomes of patients diagnosed with locally advanced NPC who received IC followed by CCRT with those who underwent CCRT alone. Conducted retrospectively, this study evaluates survival rates and treatment response between the two groups. The findings provide crucial data on whether induction chemotherapy offers a survival advantage. This study aims to contribute to the determination of the optimal therapeutic approach for locally advanced NPC. Materials and Methods: A total of 78 patients aged 18 years and older who were diagnosed with locally advanced nasopharyngeal carcinoma and followed up or undergoing treatment at the Pamukkale University Department of Medical Oncology between 2018 and 2023 were included in the study. The study population consisted of patients who received induction chemotherapy (IC) or concurrent chemoradiotherapy (CCRT) as part of their treatment. Clinical and laboratory data of the patients were retrospectively collected from medical records and the hospital information system. The relationship between patients' vi demographic characteristics, laboratory parameters, clinical status, treatments received, and survival outcomes was analyzed. Results: Among patients diagnosed with locally advanced nasopharyngeal carcinoma, those who received only concurrent chemoradiotherapy (CCRT) as initial treatment had higher 5-year and 10-year overall survival (OS) rates compared to those who received induction chemotherapy followed by CCRT (IC+CCRT). The effect of the initial treatment modality on OS was found to be statistically significant (p=0.028). Similarly, patients who received only CCRT as initial treatment had higher 5-year and 10-year progression-free survival (PFS) rates compared to those who received IC+CCRT. The effect of the initial treatment modality on PFS was also found to be statistically significant (p=0.002). In our study, no significant association was found between OS and PFS and factors such as age at diagnosis, gender, smoking status, alcohol consumption, BMI, Epstein-Barr virus (EBV) status, p16 status, and disease stage. Conclusion: In conclusion, our study found that concurrent chemoradiotherapy (CCRT) as the initial treatment had a significantly better impact on survival in patients diagnosed with locally advanced nasopharyngeal carcinoma. However, the number of patients evaluated in our study does not constitute a large sample size. Further studies with larger cohorts are needed to clarify the discrepancies observed in the literature. Keywords: Nasopharyngeal carcinoma, induction chemotherapy, concurrent chemoradiotherapy, survival