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Background <p>Concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy (AC) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). However, the optimal duration of oral AC remains poorly defined.</p> Methods <p>This study examined newly diagnosed patients between April 2017 and December 2020. The primary endpoint was overall survival (OS). Restricted cubic splines (RCS) and Kaplan–Meier method were used to evaluate the relationship between AC maintenance and survival. Inverse probability of treatment weighting (IPTW) was used to control for confounding factors.</p> Results <p>The RCS demonstrated an L-shaped association between oral AC maintenance and OS. The risk of mortality was relatively flat after 12 months. Patients with oral AC duration &gt;186 days (defined by RCS) had a significantly better OS (HR 0.23 [95% CI 0.10–0.55], log-rank p &lt; 0.001), with a higher 3-year OS rate (98.7% [95% CI 96.8–100.0] vs 88.3% [95% CI 82.5–94.5]). For patients with pretreatment Epstein-Barr virus (EBV) DNA level &gt;4000 copies/mL, mortality risk decreased to 1 at 194 days of AC duration.</p> Conclusions <p>The optimal duration of oral AC after CCRT was &gt;186 days (6 months) for LA-NPC. And the maintenance beyond 12 months may not bring additional benefits.</p>

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Determining the optimal duration of oral adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月6日

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  • Hui Cheng,
  • Jie Chen,
  • Yifu Li,
  • Yuchen Li,
  • Chunfung TSE,
  • Bowen Shen,
  • Shibing Li,
  • Qiuyan Chen,
  • Linquan Tang,
  • Haiqiang Mai,
  • Liting Liu

摘要

Background

Concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy (AC) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). However, the optimal duration of oral AC remains poorly defined.

Methods

This study examined newly diagnosed patients between April 2017 and December 2020. The primary endpoint was overall survival (OS). Restricted cubic splines (RCS) and Kaplan–Meier method were used to evaluate the relationship between AC maintenance and survival. Inverse probability of treatment weighting (IPTW) was used to control for confounding factors.

Results

The RCS demonstrated an L-shaped association between oral AC maintenance and OS. The risk of mortality was relatively flat after 12 months. Patients with oral AC duration >186 days (defined by RCS) had a significantly better OS (HR 0.23 [95% CI 0.10–0.55], log-rank p < 0.001), with a higher 3-year OS rate (98.7% [95% CI 96.8–100.0] vs 88.3% [95% CI 82.5–94.5]). For patients with pretreatment Epstein-Barr virus (EBV) DNA level >4000 copies/mL, mortality risk decreased to 1 at 194 days of AC duration.

Conclusions

The optimal duration of oral AC after CCRT was >186 days (6 months) for LA-NPC. And the maintenance beyond 12 months may not bring additional benefits.