N2-3 Stage Nasopharyngeal Carcinoma Patients With Cervical Node Necrosis And Extracapsular Spread Benefit From Capecitabine Maintenance Chemotherapy

Abstract Purpose: The purpose of this study was to analyze the efficacy and toxicities of concurrent chemoradiotherapy plus capecitabine maintenance chemotherapy for N2-3 stage nasopharyngeal carcinoma (NPC) with cervical node necrosis (CNN) and extracapsular spread(ECS).Patients and methods: This study included 283 N2-3 stage NPC patients with CNN and extracapsular spread who were treated with concurrent chemoradiotherapy. The prescribed doses delivered to the planning target volumes (PTVs), PTVnx, PTVnd, PTV1, and PTV2, were 68–72, 66–70, 60–64, and 52–56 Gy, respectively, in 30–32 fractions. All patients received induction chemotherapy followed by concurrent chemoradiotherapy with cisplatin alone (80–100 mg/m2, day 1, every 21 days is a cycle).Two weeks after completion of concurrent chemoradiotherapy, oral capecitabine (twice daily after meals for 14 consecutive days every 3 weeks) was administered to maintenance chemotherapy patients. Maintenance chemotherapy was administered for 6 months.Results: The 5-year overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 84.8%, 95.4%, and 86.6%, respectively, for all patients. The 5-year OS rates for patients who accepted capecitabine maintenance chemotherapy (group 1) and patients without maintenance chemotherapy (group 2) were 93.8% and 82.1% (P=0.021), respectively. The 5-year LRFS rates for groups 1 and 2 were 96.9% and 95.0% (P=0.467), respectively. The 5-year DMFS rates for groups 1 and 2 were 93.8% and 84.4% (P=0.044), respectively. Hand-Foot syndrome, myelotoxic effects, fatigue, and gastrointestinal symptoms were the common but not severe (grades 1–2) toxicities of the capecitabine maintenance chemotherapy.Conclusion: Capecitabine maintenance chemotherapy improves the outcome and reduces the occurrence of distant failure in N2-3 stage NPC patients with CNN and extracapsular spread. The side effects of treatment were generally tolerated. More clinical trials are required to evaluate the efficacy and toxicity of it.