Efficacy and safety of neoadjuvant chemotherapy plus concurrent chemoradiotherapy in locally advanced nasopharyngeal cancer: A real-world study.

INTRODUCTION: Treatment of locally advanced nasopharyngeal carcinoma with neoadjuvant chemotherapy followed by concomitant chemoradiotherapy has shown an overall survival advantage over concomitant chemoradiotherapy alone in several clinical trials. However, data on its efficacy in low- and intermediate incidence regions remains limited. The aim of this study is to assess the efficacy and toxicity of this approach in a Moroccan cohort.

METHODS: We conducted a retrospective analysis involving 95 patients with stage III-IVA nasopharyngeal carcinoma treated at the National Institute of Oncology in Rabat, Morocco, from January 2018 to December 2021. Eligible patients received at least one cycle of neoadjuvant chemotherapy prior to concomitant chemoradiotherapy. The collected data included patient characteristics, treatment regimens, and therapeutic outcomes, including overall survival, locoregional recurrence-free survival, distant metastasis-free survival, as well as acute toxicity.

RESULTS: Median follow-up was 41.5 months. The 5-year overall survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 67%, 81.3%, and 75.7%, respectively. Independent prognostic factors for overall survival included age (P<0.002), body mass index (P=0.002), and nodal stage (P=0.005). Grade≥3 acute toxicities occurred in 30.9% during neoadjuvant chemotherapy and 62.8% during concomitant chemoradiotherapy. Five treatment-related deaths occurred.

CONCLUSION: Neoadjuvant chemotherapy followed by concomitant chemoradiotherapy for locally advanced nasopharyngeal carcinoma yields acceptable outcomes in real-world settings. However, the high rate of acute toxicities highlights the need for rigorous patient selection and appropriate management of side effects.