{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T07:12:58Z","timestamp":1794467578202,"version":"4.9.1"},"reference-count":32,"publisher":"Wiley","issue":"16","license":[{"start":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T00:00:00Z","timestamp":1591228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003808","name":"Hospital Authority","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003808","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,8,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>A current recommendation for the treatment of patients with locoregionally advanced nasopharyngeal carcinoma (NPC) is conventional fractionated radiotherapy (RT) with concurrent cisplatin followed by adjuvant cisplatin and 5\u2010fluorouracil (PF). This randomized NPC\u20100501 trial evaluated the therapeutic effect of changing to an induction\u2010concurrent sequence or accelerated\u2010fractionation sequence, and\/or replacing 5\u2010fluorouracil with capecitabine (X).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with American Joint Committee on Cancer\/International Union Against Cancer stage III to stage IVB NPC initially were randomly allocated to 1 of 6 treatment arms (6\u2010arm full\u2010randomization cohort). The protocol was amended in 2009 to permit centers to opt out of randomization regarding fractionation (3\u2010arm chemotherapy cohort).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 803 patients were accrued (1 of whom was nonevaluable) from 2006 to 2012. Based on the overall comparisons, neither changing the chemotherapy sequence nor accelerated fractionation improved treatment outcome. However, secondary analyses demonstrated that when adjusted for RT parameters and other significant factors, the induction\u2010concurrent sequence, especially the induction\u2010PX regimen, achieved significant improvements in progression\u2010free survival (PFS) and overall survival. Efficacy varied among different RT groups: although no impact was observed in the accelerated\u2010fractionation group and the 3\u2010arm chemotherapy cohort, a comparison of the induction\u2010concurrent versus concurrent\u2010adjuvant sequence in the conventional\u2010fractionation group demonstrated a significant benefit in PFS (78% vs 62% at 5\u00a0years; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.015) and a marginal benefit in overall survival (84% vs 72%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.042) after adjusting for multiple comparisons. Comparison of the induction\u2010PX versus the adjuvant\u2010PF regimen demonstrated better PFS (78% vs 62%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.027) without an increase in overall late toxicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For patients irradiated using conventional fractionation, changing the chemotherapy sequence from a concurrent\u2010adjuvant to an induction\u2010concurrent sequence, particularly using induction cisplatin and capecitabine, potentially could improve efficacy without an adverse impact on late toxicity. However, further validation is needed for confirmation of these findings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32972","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T13:16:55Z","timestamp":1591276615000},"page":"3674-3688","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["NPC\u20100501 trial on the value of changing chemoradiotherapy sequence, replacing 5\u2010fluorouracil with capecitabine, and altering fractionation for patients with advanced nasopharyngeal carcinoma"],"prefix":"10.1002","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2972-0231","authenticated-orcid":false,"given":"Anne W. 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