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Lin CS, Chen YW, Liu SC, Tsao CC, Lin KT, Lee SP, Fan CY, Liu MY, Shen PC, Jen YM. Treatment outcomes with whole-field versus split-field intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma. Head Neck 2018; 41:598-605. [DOI: 10.1002/hed.25328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/11/2018] [Accepted: 04/19/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine; Taipei Medical University; Taipei Taiwan
| | - Yuan-Wu Chen
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Shao-Cheng Liu
- Department of Otolaryngology - Head and Neck Surgery, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Chih-Cheng Tsao
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Steve P. Lee
- Department of Radiation Oncology, David Geffen School of Medicine; University of California; Los Angeles California
| | - Chao-Yueh Fan
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Ming-Yueh Liu
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Po-Chien Shen
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
- Department of Radiation Oncology; Yee Zen General Hospital; Taoyuan Taiwan
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152
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Zhang J, Peng H, Li WF, Zhang Y, Liu LZ, Tian L, Lin AH, Sun Y, Ma J. Individualized induction chemotherapy by pre-treatment plasma Epstein-Barr viral DNA in advanced nasopharyngeal carcinoma. BMC Cancer 2018; 18:1276. [PMID: 30567511 PMCID: PMC6299978 DOI: 10.1186/s12885-018-5177-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 12/04/2018] [Indexed: 04/27/2023] Open
Abstract
Background The role of pretreatment Epstein-Barr virus DNA (pre-DNA) for individualized induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC) still remains unknown. We aimed to address this clinical issue. Methods In total, data on 6218 patient with newly diagnosed LA-NPC receiving concurrent chemoradiotherapy (CCRT) with or without IC were retrospectively reviewed. Receiver operating characteristics (ROC) curve was adopted to calculate the cut-off value of pre-DNA based on disease-free survival (DFS). Propensity score matching (PSM) method was adopted to balance prognostic factors and match patients. Survival outcomes between IC + CCRT and CCRT groups were compared. Results Among the original cohort, no survival difference between IC + CCRT and CCRT groups was found. The cut-off value of pre-DNA was 4650 copies/ml (area under curve [AUC], 0.620; sensitivity, 0.6224; specificity, 0.5673). For patients with Pre-DNA ≤ 4650 copies/ml, the IC + CCRT and CCRT groups also achieved comparable survival outcomes (P > 0.05 for all rates). However, IC + CCRT was associated with significantly improved 3-year DFS (78.6% vs. 74.8%, P = 0.03), overall survival (OS; 91.4% vs. 87.5%, P = 0.002) and distant metastasis-free survival (DMFS; 86.0% vs. 82.2%, P = 0.036) for patient with pre-DNA > 4650 copies/ml. Multivariate analysis also confirm that IC + CCRT was an independent prognostic factor for DFS (HR, 0.817; 95% CI, 0.683–0.977; P = 0.027), OS (HR, 0.675; 95% CI, 0.537–0.848; P = 0.001) and DMFS (HR, 0.782; 95% CI, 0.626–0.976; P = 0.03). Conclusions Pre-DNA may be a feasible and powerful consideration for individualized IC apart from other baseline clinical characteristics in LA-NPC. Electronic supplementary material The online version of this article (10.1186/s12885-018-5177-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian Zhang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510000, People's Republic of China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, People's Republic of China
| | - Hao Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, People's Republic of China
| | - Wen-Fei Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, People's Republic of China
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, People's Republic of China
| | - Li-Zhi Liu
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Li Tian
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, People's Republic of China. .,State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
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153
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Liu M, You W, Song YB, Miao JD, Zhong XB, Cai DK, Xu L, Xie LF, Gao Y. The Changing Role of Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma: A Updated Systemic Review and Network Meta-Analysis. Front Oncol 2018; 8:597. [PMID: 30619740 PMCID: PMC6305856 DOI: 10.3389/fonc.2018.00597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/26/2018] [Indexed: 01/12/2023] Open
Abstract
Background and Objective: Both induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT; IC+CCRT) and CCRT plus adjuvant chemotherapy (AC; CCRT+AC) are standard treatments for advanced nasopharyngeal carcinoma (NPC). However, no prospective randomized trials comparing these two approaches have been published yet. We conducted this network meta-analysis to address this clinical question. Method: We recruited randomized clinical trials involving patients with advanced NPC randomly allocated to IC+CCRT, CCRT+AC, CCRT, or radiotherapy (RT) alone. Pairwise meta-analysis was first conducted, then network meta-analysis was performed using the frequentist approach. Effect size was expressed as hazard ratio (HR) and 95% confidence interval (CI). Results: Overall, 12 trials involving 3,248 patients were recruited for this study, with 555 receiving IC+CCRT, 840 receiving CCRT+AC, 1,039 receiving CCRT, and 814 receiving radiotherapy (RT) alone. IC+CCRT achieved significantly better overall survival ([HR], 0.69; 95% [CI], 0.51–0.92), distant metastasis-free survival (HR, 0.58; 95% CI, 0.44–0.78), and locoregional recurrence-free survival (HR, 0.67; 95% CI, 0.47–0.98) than CCRT. However, survival outcomes did not significantly differ between IC+CCRT and CCRT+AC, or between CCRT+AC and CCRT arms for all the endpoints. As expected, RT alone is the poorest treatment. In terms of P-score, IC+CCRT ranked best for overall survival (96.1%), distant metastasis-free survival (99.0%) and locoregional recurrence-free survival (87.1%). Conclusions: IC+CCRT may be a better and more promising treatment strategy for advanced NPC; however, head-to-head randomized trials comparing IC-CCRT with CCRT-AC are warranted.
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Affiliation(s)
- Mei Liu
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Wei You
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Yi-Bing Song
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Ji-Dong Miao
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Xiu-Bo Zhong
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Dian-Kun Cai
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Lun Xu
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Lu-Feng Xie
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
| | - Yang Gao
- Department of Oncology, Zigong NO. 4 People's Hospital, Zigong, China
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Abstract
OBJECTIVE To analyze the clinical outcome and prognostic factors of N3 nasopharyngeal carcinomas (NPCs), provide a basis for rational treatment and improve the cure rate. METHODS A total of 110 patients with a pathologically confirmed diagnosis of N3 (NPC 2008 stage in China) NPC from our hospital were retrospectively included in the study conducted from April 2007 to July 2011. All patients received intensity-modulated radiation therapy. Some of these patients received various chemotherapies. The doses of the planning gross primary tumor and retropharyngeal lymph node volume, high-risk planning tumor volume, low-risk planning tumor volume, and gross tumor volume of neck lymph nodes were 6000 to 7600, 5400 to 6600, 5000 to 6000, and 6000 to 6996 cGy, respectively. The Kaplan-Meier analysis and logrank test were carried out to calculate and compare the survival rates of the patients, and the Statistical Package for the Social Sciences software version 17.0 was used for all analyses. Meanwhile, the Cox model was used to analyze the prognostic factors. RESULTS In this study, the 1-, 3-, and 5-year overall survival rates of the patients were 92.63%, 83.16%, and 70.53%, respectively. Based on the univariate analysis, T stage (P = .043) and chemotherapy (P = .003) were significant factors for survival. In the multivariate analysis, only chemotherapy influenced survival (). Recent toxicity included radioactive oral mucosa inflammation and skin injury, and difficulty opening the mouth and hearing loss were considered late adverse reactions. None of the patients died during treatment.(Table is included in full-text article.) CONCLUSIONS:: Patients with N3 NPC are at high risk of distant metastasis, and their 5-year survival rate is poor. The more important prognostic factors were T stage and chemotherapy. Patients with N3 NPC should be treated with combined chemotherapy and radiotherapy.
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155
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Characterization of PD-L1 and PD-1 Expression and CD8+ Tumor-infiltrating Lymphocyte in Epstein-Barr Virus-associated Nasopharyngeal Carcinoma. Am J Clin Oncol 2018; 41:1204-1210. [DOI: 10.1097/coc.0000000000000449] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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156
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Liu T, Sun Q, Chen J, Wang F, Li B, Qin W, Ye Z, Hu F. A comparison of neoadjuvant chemotherapy with gemcitabine versus docetaxel plus cisplatin in locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis. Cancer Manag Res 2018; 10:6237-6245. [PMID: 30538570 PMCID: PMC6260124 DOI: 10.2147/cmar.s186233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the efficacy and safety of neoadjuvant chemotherapy (NACT) with gemcitabine (GEM) vs docetaxel plus cisplatin (CDDP) in locoregionally advanced nasopharyngeal carcinoma (NPC). Methods A total of 222 patients with locoregionally advanced NPC between February 2012 and May 2014 in our hospital who received NACT with GEM or docetaxel plus CDDP combined with concurrent chemoradiotherapy (CCRT) were retrospectively analyzed. Fifty-two patients treated with GEM plus CDDP (GP) combined with CCRT were matched with 52 patients who received docetaxel plus CDDP (TP) combined with CCRT. Results With a median follow-up time of 60 months (range, 14–72 months), the 5-year overall survival, progression-free survival (PFS), local relapse-free survival and distant metastasis-free survival (DMFS) rates were 78.8%, 66.0%, 81.0% and 75.9%, respectively, in the GP group and 79.4%, 60.5%, 79.6% and 73.6%, respectively, in the TP group. No statistically significant survival differences were found between the two groups. In multivariate analysis, T3–4 and N2–3 were prognostic factors for poor 5-year PFS and DMFS (all P-values <0.05). Patients in the TP group experienced less grade 3–4 thrombocytopenia but more grade 3–4 leucopenia and neutropenia than those in the GP group (all P-values <0.05). There were no significant differences between the two groups in other toxicities (all P-values >0.05). Conclusion NACT with GP or TP regimen achieved comparable clinical outcome with acceptable toxicities. Both regimens might be a treatment option for patients with locoregionally advanced NPC.
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Affiliation(s)
- Tongxin Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China, .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China,
| | - Quanquan Sun
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China,
| | - Jing Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China, .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China,
| | - Fangzheng Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China, .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China,
| | - Bin Li
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China, .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China,
| | - Weifeng Qin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China, .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China,
| | - Zhimin Ye
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China, .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China,
| | - Fujun Hu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China, .,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, China, .,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China,
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157
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Chen Q, Tang L, Liu N, Han F, Guo L, Guo S, Wang J, Liu H, Ye Y, Zhang L, Liu L, Wang P, Li Y, He Q, Yang X, Tang Q, Li Y, Liang Y, Sun X, Xie C, Mo Y, Guo Y, Sun R, Mo H, Cao K, Guo X, Zeng M, Mai H, Ma J. Famitinib in combination with concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 1, open-label, dose-escalation Study. Cancer Commun (Lond) 2018; 38:66. [PMID: 30382933 PMCID: PMC6235389 DOI: 10.1186/s40880-018-0330-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/15/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Famitinib is a tyrosine kinase inhibitor against multiple targets, including vascular endothelial growth factor receptor 2/3, platelet-derived growth factor receptor, and stem cell factor receptor (c-kit). Previous studies have demonstrated anti-tumour activities of famitinib against a wide variety of advanced-stage solid cancers. We aimed to determine the safety and efficacy of famitinib with concurrent chemoradiotherapy (CCRT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). We also evaluated the feasibility of contrast-enhanced ultrasound (D-CEUS) as a predictor of early tumour response to famitinib and to correlate functional parameters with clinical efficacy. METHODS The trial was conducted in subjects with stage III or IVa-b NPC using a 3 + 3 design of escalating famitinib doses. Briefly, subjects received 2 weeks of famitinib monotherapy followed by 7 weeks of famitinib plus CCRT. D-CEUS of the neck lymph nodes was performed at day 0, 8 and 15 after famitinib was administered before starting concurrent chemoradiotherapy. End points included safety, tolerability and anti-tumour activity. RESULTS Twenty patients were enrolled (six each for 12.5, 16.5 and 20 mg and two for 25 mg). Two patients in the 25 mg cohort developed dose-limiting toxicities, including grade 4 thrombocytopenia and grade 3 hypertension. The most common grade 3/4 adverse events were leukopenia, neutropenia and radiation mucositis. D-CEUS tests showed that more than 60% of patients achieved a perfusion parameter response after 2 weeks taking famitinib alone, and the parameter response was associated with disease improvement. In the famitinib monotherapy stage, three patients (15%) showed partial responses. The complete response rate was 65% at the completion of treatment and 95% 3 months after the treatment ended. After a median follow-up of 44 months, the 3-year progression-free survival (PFS) and distant metastasis-free survival were 70% and 75%, respectively. Subjects with a decrease of perfusion parameter response, such as peak intensity decreased at least 30% after 1 week of famitinib treatment, had higher 3-year PFS (90.9% vs. 44.4%, 95% CI 73.7%-100% vs. 11.9%-76.9%, P < 0.001) than those with an increase or a reduction of less than 30%. CONCLUSIONS The recommended famitinib dose for phase II trial is 20 mg with CCRT for patients with local advanced NPC. D-CEUS is a reliable and early measure of efficacy for famitinib therapies. Further investigation is required to confirm the effects of famitinib plus chemoradiotherapy.
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Affiliation(s)
- Qiuyan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Linquan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Na Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Feng Han
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Ling Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Shanshan Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Jianwei Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Huai Liu
- Department of Radiation Oncology, Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, P. R. China
| | - Yanfang Ye
- Department of Science and Education, Sun Yat-sen Memorial Hospital, Guangzhou, 510120, P. R. China
| | - Lu Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, P. R. China
| | - Liting Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Pan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Yingqin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Qingmei He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Xiaoqun Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Qingnan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Yang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - YuJing Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - XueSong Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Chuanmiao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Imaging, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Yunxian Mo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Imaging, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Ying Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Clinical Trial Center, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Rui Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Haoyuan Mo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Kajia Cao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Musheng Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Haiqiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.
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158
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Zeng Z, Yan RN, Tu L, Wang YY, Chen PR, Luo F, Liu L. Assessment of Concurrent Chemoradiotherapy plus Induction Chemotherapy in Advanced Nasopharyngeal Carcinoma: Cisplatin, Fluorouracil, and Docetaxel versus Gemcitabine and Cisplatin. Sci Rep 2018; 8:15581. [PMID: 30348970 PMCID: PMC6197284 DOI: 10.1038/s41598-018-33614-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/14/2018] [Indexed: 02/05/2023] Open
Abstract
Induction chemotherapy treatment for nasopharyngeal carcinoma (NPC) is controversial. The aim of this study was to evaluate the treatment outcomes and toxicities between two induction chemotherapy regimens, with both followed by concurrent chemoradiotherapy. The first strategy used docetaxel, cisplatin and fluorouracil for induction chemotherapy (TPF), and the second utilised gemcitabine and cisplatin (GP). A retrospective analysis was performed on eligible NPC patients attending our hospital between May 2009 and Dec 2014. A total of 113 patients were enrolled with 58 patients receiving TPF and 55 receiving GP induction chemotherapy. Ninety-four patients (83.2%) were alive after 36-months follow-up. The median overall survival (OS) and progression-free survival (PFS) time were 48.3 and 39.7 months, respectively. The 3-year OS for the TPF regimen was 87.9% and 87.4% with GP chemotherapy (P = 0.928). The 3-year PFS of the TPF treatment was 84.5%, while it was 83.5% for the GP group (P = 0.551). Univariate analysis showed that lymph node metastasis was a significant PFS prognostic factor, while N3 stage was an independent predictor of PFS and distant failure-free survival (DMFS) in multivariate analysis. There were no significant differences in adverse toxicities or treatment efficacy between the chemotherapy regimens in the treatment of locoregionally advanced NPC.
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Affiliation(s)
- Zhen Zeng
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, and Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruo-Nan Yan
- Department of Head and Neck Oncology, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Li Tu
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, and Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yu-Yi Wang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, and Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Pei-Ran Chen
- Sichuan University, Chengdu, 610041, Sichuan, China
| | - Feng Luo
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, and Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lei Liu
- Department of Head and Neck Oncology, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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159
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Value of early evaluation of treatment response using 18F-FDG PET/CT parameters and the Epstein-Barr virus DNA load for prediction of outcome in patients with primary nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging 2018; 46:650-660. [DOI: 10.1007/s00259-018-4172-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022]
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160
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Zhu Q, Hu H, Tang LQ, You R, Zhao JJ, Weng DS, Pan QZ, Chen CL, Zhou ZQ, Tang Y, Xia JC. Weekly versus triweekly cisplatin plus intensity-modulated radiotherapy in locally advanced nasopharyngeal carcinoma: A propensity score analysis with a large cohort. J Cancer 2018; 9:3447-3455. [PMID: 30310501 PMCID: PMC6171032 DOI: 10.7150/jca.26110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/23/2018] [Indexed: 01/12/2023] Open
Abstract
Purpose: To directly compare the efficacy and acute toxicities of intensity-modulated radiotherapy (IMRT) concurrent with weekly cisplatin (40 mg/m2) to high-dose concurrent cisplatin (100 mg/m2) at three-week intervals. Materials and Methods: A total of 3,799 patients diagnosed with locally advanced nasopharyngeal carcinoma (NPC) at Sun Yat-Sen University Cancer Center between January 2010 and December 2013 were retrospectively reviewed. Propensity score analysis was conducted to balance the baseline characteristics between the groups, which allowed us to draw reliable conclusions. The efficacy and safety profiles were then assessed in the well-balanced large cohort. Results: The risk of distant metastasis was lower among the patients treated with weekly concurrent cisplatin than among those treated with the triweekly regimen (hazard ratio [HR], 0.45; P = .028). However, the disease-free survival, loco-regional relapse-free survival and overall survival rates were similar. The weekly group showed significantly higher rates of grade 3-4 thrombocytopenia, but lower rates of grade 3-4 mucositis, nausea and vomiting than the triweekly group. Conclusion: IMRT concurrent with a weekly cisplatin regimen was associated with significantly improved distant metastasis-free survival in locally advanced NPC. Differences in the selected acute toxicities between the weekly and triweekly concurrent cisplatin regimens were noted.
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Affiliation(s)
- Qian Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Hao Hu
- Department of Surgery, Medical College of Nanchang University, Nanchang 330006, People's Republic of China
| | - Lin-Quan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Rui You
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Jing-Jing Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - De-Sheng Weng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Qiu-Zhong Pan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Chang-Long Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Zi-Qi Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Yan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Jian-Chuan Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.,Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
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161
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Zhou S, Chen C, Liu SR, Tao YL, Chang H, Wang XH, Yang X, Zhang WW, Liu S, Ding SR, Wang GN, Xia YF. Surrogate endpoints shortening the therapeutic evaluation duration for different subgroups of patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: A retrospective analysis of 830 patients stratified by the 8th edition of the UICC/AJCC staging system and plasma Epstein-Barr viral. J Cancer 2018; 9:3352-3360. [PMID: 30271496 PMCID: PMC6160691 DOI: 10.7150/jca.25530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Abstract
Purpose: Investigating surrogate endpoints shortening the time of therapeutic evaluation in nasopharyngeal carcinoma (NPC) after radical treatment. Patients and Methods: We retrospectively analyzed 830 patients receiving intensity-modulated radiotherapy (IMRT) from 2008 to 2010 and being stratified by the 8th edition of UICC/AJCC staging system and the plasma Epstein-Barr virus DNA (EBV DNA). The annual rates of overall survival (OS), progression-free survival (PFS), loco-regional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were sequentially calculated using the life table and compared by the McNemar method. Results: The time of shortening therapeutic evaluation by surrogate endpoints: OS, PFS, LRFS and DMFS could be shortened to 1-year (100% vs 100%, P=1) in patients with stage I; OS, PFS, LRFS and DMFS could be shortened to 3-year (96.9% vs 96.1%, P = 1; 94.6% vs 92.2%, P = 0.125; 96.9% vs 95.3%, P = 0.5) and 4-year (92.2% vs 91.2%, P = 0.125) in stage II; In the high EBV DNA group , OS and DMFS could be shortened to 1-year (100% vs 100%, P = 1;100% vs 100%, P = 0.25) in stage II; OS and PFS could be shortened to 3-year (94.3% vs 91.4%, P = 1;82.9% vs 74.3%, P = 0.25) in stage III; OS could be shortened to 4-year (75% vs 72.7%, P = 1) in stage IVA. Conclusions: The time of therapeutic evaluation could be shortened to <5-year in stages I-II patients. The year of surrogate endpoints could be ahead in stages II-IVA with high EBV DNA.
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Affiliation(s)
- Shu Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Chen Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Song-Ran Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Ya-Lan Tao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Hui Chang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Xiao-Hui Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Xin Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Wen-Wen Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Shan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Shi-Rong Ding
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Guan-Nan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, P. R. China
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162
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Liu T, Sun Q, Chen J, Li B, Qin W, Wang F, Ye Z, Hu F. Neoadjuvant Chemotherapy with Fluorouracil plus Nedaplatin or Cisplatin for Locally Advanced Nasopharyngeal Carcinoma: a Retrospective Study. J Cancer 2018; 9:3676-3682. [PMID: 30405836 PMCID: PMC6216018 DOI: 10.7150/jca.27198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/15/2018] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to evaluate the efficacy, toxicity and long-term outcome of nedaplatin or cisplatin combined with 5-fluorouracil neoadjuvant chemotherapy (NF or PF regimen) followed by concurrent chemoradiotherapy (CCRT) for treatment of locally advanced nasopharyngeal carcinoma (NPC). In this study, a total of 186 patients with locally advanced NPC between January 2009 and November 2011 in our center were retrospectively analyzed. 103 cases were received NF neoadjuvant chemotherapy followed by nedaplatin concurrent intensity-modulated radiotherapy (IMRT), and 83 cases were received PF neoadjuvant chemotherapy followed by cisplatin concurrent IMRT. Overall survival (OS), progression-free survival (PFS), local relapse-free survival (LRFS), regional relapse-free survival (RRFS) and distant metastasis-free survival (DMFS), as well as acute toxicities were monitored. Results showed that there were no significant differences in 5-year OS, PFS, LRFS, RRFS and DMFS between NF and PF groups. NF group had a higher incidence of grade 3-4 neutropenia (46.6% vs. 31.3%, P=0.035) and thrombocytopenia (17.5% vs. 7.3%, P=0.042) compared with PF group. However, NF group was less common to suffer from grade 3-4 nausea (1.9% vs. 24.1%, P<0.001), vomiting (0% vs. 13.3%, P<0.001) and weight loss (0% vs. 4.8%, P=0.025). In multivariate analysis, N stage was an independent factor for OS, PFS, RRFS and DMFS. In conclusion, neoadjuvant chemotherapy with fluorouracil plus nedaplatin followed by nedaplatin concurrent with IMRT exhibited similar efficacy but more tolerable toxicity than cisplatin setting, which might be an effective and safe choice for treatment of locally advanced NPC.
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Affiliation(s)
- Tongxin Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China
| | - Quanquan Sun
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China
| | - Jing Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China
| | - Bin Li
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China
| | - Weifeng Qin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China
| | - Fangzheng Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China
| | - Zhimin Ye
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China
| | - Fujun Hu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China
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163
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Li PJ, Mo HY, Luo DH, Hu WH, Jin T. The efficacy of induction chemotherapy in the treatment of stage II nasopharyngeal carcinoma in intensity modulated radiotherapy era. Oral Oncol 2018; 85:95-100. [PMID: 30220326 DOI: 10.1016/j.oraloncology.2018.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/16/2018] [Accepted: 08/25/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of induction chemotherapy in the treatment of stage II nasopharyngeal carcinoma (NPC) in era of intensity modulated radiotherapy (IMRT). METHODS AND MATERIALS A total of 173 patients with American Joint Committee on Cancer (AJCC) 7th stage II NPC from two institutions were included. All patients were divided into two groups: induction chemotherapy + concurrent chemoradiotherapy group (ICRT) group and concurrent chemoradiotherapy group (CCRT). Induction chemotherapy was consisted of one to three cycles of cisplatin plus fluorouracil (PF) or paclitaxel plus cisplatin (TP). Concurrent chemotherapy included one to three cycles of cisplatin. We retrospectively assessed overall survival (OS), progression-free survival (PFS), locoregional failure free survival (LRFFS) and distant metastasis free survival (DMFS) in patients of both groups. T-test, Chi-square test, Kaplan-Meier methodology and Cox proportional hazards model were used to analyze. RESULTS With a median follow up of 64.7 months, no significant difference was found in grade 3-4 hematologic toxicity, liver dysfunction and renal impairment between ICRT and CCRT group. Univariable analyses shown adding induction chemotherapy to CCRT significantly decreased 5-year OS (87.9% vs 95.5%, P = 0.033), 5-year PFS (74.0% vs 86.1%, P = 0.035), 5-year LRFFS (80.0% vs 91.2%, P = 0.016), but there was no statistically significant difference in 5-year DMFS (87.1% vs 94.7%, P = 0.095). In multivariable analyses, we found the consistent results that induction chemotherapy was a negative factor associated with OS (HR of death = 3.768, 95% CI = 1.117-12.709; P = 0.032), PFS (HR of progression = 2.156, 95% CI = 1.060-4.386; P = 0.034), LRFFS (HR of locoregional relapse = 2.435, 95% CI = 1.009-5.874; P = 0.048) and also DMFS (HR of metastasis = 2.873, 95% CI = 1.005-8.211; P = 0.049), in stage II NPC patients. CONCLUSION In present study, we found that induction chemotherapy caused deleterious effect on stage II NPC patients. However, this is a retrospective study and the adverse effects of induction chemotherapy has not been previously reported. It warrants further investigation.
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Affiliation(s)
- Pei-Jing Li
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, People's Republic of China
| | - Hao-Yuan Mo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Dong-Hua Luo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wei-Han Hu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ting Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, People's Republic of China.
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164
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Liang H, Lv X, Wang L, Wu YS, Sun R, Ye YF, Ke LR, Yang Q, Yu YH, Qiu WZ, Liu GY, Huang XJ, Li WZ, Lv SH, Guo X, Xiang YQ, Xia WX. The plasma Epstein-Barr virus DNA level guides precision treatment for nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: a large population-based cohort study from an endemic area. Ther Adv Med Oncol 2018; 10:1758835918782331. [PMID: 30046357 PMCID: PMC6055246 DOI: 10.1177/1758835918782331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background: In the intensity-modulated radiotherapy (IMRT) era, the survival benefit of concurrent chemotherapy for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains undetermined. This study aimed to evaluate the benefits of IMRT with concurrent chemotherapy compared with IMRT alone for LA-NPC patients with different plasma Epstein–Barr virus (EBV) DNA levels. Methods: Patients were identified from a prospectively maintained database in an endemic area between November 2002 and December 2013. Cox proportional hazards models, propensity score matching, and inverse probability weighting models were established for survival analysis. Stratification analysis was performed based on interaction effects analysis. Finally, sensitivity analysis was performed considering unmeasured confounders. Results: A total of 1357 eligible patients were enrolled (median follow up 62.4 months; range 3.5–155.8 months). No significant survival differences were observed between groups in the entire cohort. Notably, a significant interaction effect was observed between treatment regimens and EBV DNA levels. In patients with high EBV DNA levels (>4000 copies/ml), all three models showed that IMRT with concurrent chemotherapy significantly improved overall survival [hazard ratio (HR) 2.521, 95% confidence interval (CI) 1.218–5.216], disease-free survival (HR 2.168, 95% CI 1.349–3.483), and distant metastasis-free survival (HR 2.331, 95% CI 1.194–4.551) compared with IMRT alone. No differences were found in patients with low EBV DNA levels. Sensitivity analysis confirmed the robustness of the results. Conclusion: In the IMRT era, concurrent chemotherapy treatment of LA-NPC patients with high EBV DNA levels is reasonable. However, the optimal regimen for LA-NPC patients with low EBV DNA levels needs further validation in randomized clinical trials.
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Affiliation(s)
- Hu Liang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xing Lv
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Lin Wang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yi-Shan Wu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rui Sun
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yan-Fang Ye
- Clinical Trial Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang-Ru Ke
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qin Yang
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ya-Hui Yu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wen-Ze Qiu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Guo-Ying Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xin-Jun Huang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wang-Zhong Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Shu-Hui Lv
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yan-Qun Xiang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wei-Xiong Xia
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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165
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Gabani P, Barnes J, Lin AJ, Rudra S, Oppelt P, Adkins D, Rich JT, Zevallos JP, Daly MD, Gay HA, Thorstad WL. Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care. Cancer Med 2018; 7:3592-3603. [PMID: 30008178 PMCID: PMC6089177 DOI: 10.1002/cam4.1626] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 11/09/2022] Open
Abstract
The role of induction chemotherapy in nasopharyngeal carcinoma (NPC) remains controversial. The primary aim of this study was to use the National Cancer Database to evaluate the patterns of care of induction chemotherapy in NPC and its impact on overall survival (OS). Patients with NPC from 2004 to 2014 were obtained from the NCDB. Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT and concurrent CRT if chemotherapy started within 21 days after the start of RT. Propensity score matching was used to control for selection bias. Cox proportional hazards model was used to determine significant predictors of OS. Logistic regression model was used to determine predictors of the use of induction chemotherapy. Significance was defined as a P value <.05. A total of 4857 patients were identified: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy. The use of induction therapy remained stable between 2004 and 2014. Younger patients and those with higher T- and N-stage had a higher likelihood of being treated with induction chemotherapy. The 5-year OS in patients treated with induction chemotherapy and CRT was 66.3% vs 69.1%, respectively (P = .25). There was no difference in OS when these two groups were analyzed after propensity score matching. No differences in OS existed between these treatment groups in patients with T3-T4N1 or TanyN2-3 disease (P = .76). Propensity score matching also did not reveal any difference in OS in patients with T3-T4N1 or TanyN2-3 disease. The use of induction chemotherapy has remained stable in the last decade. In this study of patients with NPC, induction chemotherapy was not associated with improved OS compared to CRT alone.
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Affiliation(s)
- Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Justin Barnes
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Soumon Rudra
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Peter Oppelt
- Division of Medical Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Douglas Adkins
- Division of Medical Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jason T Rich
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jose P Zevallos
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Mackenzie D Daly
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA
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166
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Yu Y, Ke L, Lv X, Ling YH, Lu J, Liang H, Qiu W, Huang X, Liu G, Li W, Guo X, Xia W, Xiang Y. The prognostic significance of carcinoma-associated fibroblasts and tumor-associated macrophages in nasopharyngeal carcinoma. Cancer Manag Res 2018; 10:1935-1946. [PMID: 30022852 PMCID: PMC6042505 DOI: 10.2147/cmar.s167071] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Tumor stroma cells play an important role in the carcinogenesis and progression of cancer. The aim of the present investigation was to explore the predictive role of carcinoma-associated fibroblasts (CAFs) and tumor-associated macrophages (TAMs) in nasopharyngeal carcinoma (NPC). Patients and methods The densities of CAFs and TAMs were measured by immunohistochemistry staining for α-smooth muscle actin (α-SMA), CD68, and CD163 in two sets of tissue microarrays including 260 pretreatment NPC tissues, that is, a training test comprising of 152 patients and a validation set comprising of 108 patients. Chi-square tests were performed for comparisons among the groups. Survival rates were estimated by using the Kaplan–Meier method and compared with log-rank tests. Cox proportional hazards models were used to identify significant independent variables. Results Patients older than 50 years showed a lower expression of CD68, and there was a positive relationship between the densities of CAFs and CD163+ TAMs (p=0.001). In the multivariate analysis of the training test, both α-SMA and CD163 were independent prognostic factors for overall survival and progression-free survival (all p<0.05). Based on the expression levels of α-SMA and CD163, patients were categorized into three groups: high-risk, intermediate-risk, and low-risk groups according to both high, either high, and both low, respectively. Survival analysis and Cox multivariate analysis showed that the risk groups based on α-SMA and CD163 expression were independent predictors for the survival of patients with NPC in the training test, which was also confirmed by the validation test. Conclusion A patient’s risk group based on the level of CD163+ TAMs and CAFs was an independent predictor of survival, which may facilitate patient counseling and individualized treatment.
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Affiliation(s)
- Yahui Yu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Radiation Oncology, Oncology Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Liangru Ke
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Diagnostic Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Xing Lv
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Yi Hong Ling
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Jiabin Lu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Hu Liang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Wenze Qiu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Xinjun Huang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Guoying Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Wangzhong Li
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Xiang Guo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Weixiong Xia
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
| | - Yanqun Xiang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, People's Republic of China, ; .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China, ;
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Kong M, Lim YJ, Kim Y. Concurrent Chemoradiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma: Treatment Outcomes and
Prognostic Factors. Asian Pac J Cancer Prev 2018; 19:1591-1599. [PMID: 29936784 PMCID: PMC6103582 DOI: 10.22034/apjcp.2018.19.6.1591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: We conducted this study to contribute to resolving some controversial issues on management of nasopharyngeal carcinoma. Methods: Thirty-two patients with stage III-IVB nasopharyngeal carcinoma were included in this retrospective study. All patients received concurrent chemoradiotherapy with either 3D conformal radiotherapy or intensity-modulated radiotherapy. We retrospectively analyzed the survival outcome, prognostic factors for survival, and toxicity outcome. Results: The 2- and 5-year overall survival rates were 89.9% and 82.6%. The 2- and 5-year distant metastasis-free survival rates were 83.2% and 79.4%. The 2- and 5-year loco-regional recurrence-free survival rates were 83.3% and 79.5%. Addition of induction chemotherapy to concurrent chemoradiotherapy did not improve survival outcomes. The survival benefit of intensity-modulated radiotherapy over 3D conformal radiotherapy was not clear. Intensity-modulated radiotherapy significantly decreased the development of late toxicities compared with 3D conformal radiotherapy. Total RT dose was prognostic factor for overall, loco-regional recurrence-free, and distant metastasis-free survival. Temporary RT interruption was prognostic factor for overall survival. Daily RT dose was prognostic factor for distant metastasis-free survival. Conclusions: Concurrent chemoradiotherapy resulted in high survival rates with an acceptable level of toxicities in patients with loco-regionally advanced nasopharyngeal carcinoma. To confirm the results of this study, well-designed randomized prospective trials are warranted.
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Affiliation(s)
- Moonkyoo Kong
- Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
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168
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He Y, Guo T, Guan H, Wang J, Sun Y, Peng X. Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy: a meta-analysis. Cancer Manag Res 2018; 10:1419-1428. [PMID: 29922086 PMCID: PMC5995285 DOI: 10.2147/cmar.s160469] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose In this study, we attempted to compare the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with radiotherapy alone (RT) for locoregionally advanced nasopharyngeal carcinoma (LANPC) in the era of intensity-modulated radiotherapy (IMRT) by meta-analysis. Materials and methods We searched databases, and all randomized controlled trials meeting the inclusion criteria were utilized for a meta-analysis with RevMan 5.3 based on the Cochrane methodology. Results Fifteen studies were found suitable based on the inclusion criteria. CCRT not only significantly improved the overall response rate (risk ratio [RR]=0.53, 95% CI 0.43–0.66) and the complete response rate (RR=0.60, 95% CI 0.51–0.71) but also contributed to longer overall survival. The incidence of grade 3–4 adverse events from CCRT group increased in hematologic toxicity (RR 2.25, 95% CI 1.54–3.29), radiation-induced oral mucositis (RR 1.64, 95% CI 1.14–2.35), and radiodermatitis (RR 1.80, 95% CI 1.13–2.88). Conclusion Compared with IMRT alone, CCRT provided survival benefit with acceptable toxicity in patients with LANPC. However, we need multicenter randomized controlled trials and long-term follow-up to evaluate the eventual efficacy and toxicity of concurrent chemotherapy plus IMRT.
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Affiliation(s)
- Yan He
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Guo
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Guan
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Sun
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Kang M, Wang F, Liao X, Zhou P, Wang R. Intensity-modulated radiotherapy combined with endostar has similar efficacy but weaker acute adverse reactions than IMRT combined with chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Medicine (Baltimore) 2018; 97:e11118. [PMID: 29924009 PMCID: PMC6024473 DOI: 10.1097/md.0000000000011118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study is to compare the efficacy and adverse effects of intensity-modulated radiotherapy (IMRT) combined with endostar and IMRT combined with concurrent chemotherapy on locally advanced nasopharyngeal carcinoma (NPC).A total of 23 patients with stage III-IVa NPC were included in the present study, and randomly divided into experimental group (10 cases treated with IMRT + endostar) and control group (13 cases treated with IMRT + chemotherapy of cis-dichlorodiamineplatinum). Endostar was intravenously administered from the first day of IMRT. The patients received a total of 2 cycles (14 days each) separating by a 7-day interval.IMRT combined with endostar did not have significantly different recent efficacy compared with IMRT combined with chemotherapy. IMRT combined with endostar and IMRT combined with chemotherapy had 2-year overall survival (OS) rates of 100.0% and 69.6%, respectively, without significant difference between each other (χ = 1.446, P = .299). The 2-year local relapse-free survival (LRFS) of the 2 groups were 100.0% and 81.3%, respectively, without significant difference between each other (χ = 1.000, P = .317). The 2-year distant metastasis-free survival (DMFS) of the 2 groups were 100.0% and 73.5% (χ = 1.591, P = .207), respectively. The 2-year progression-free survival (PFS) of the 2 groups were 100.0% and 67.3% (χ = 2.164, P = .141), respectively. However, the cumulative survival curves of OS, LRFS, DMFS, and PFS were separated between the 2 groups. The result that IMRT combined with endostar did not have significantly different long-term efficacy than IMRT combined with chemotherapy probably due to limited case number and short follow-up time. IMRT combined with endostar resulted in significantly lower grades of leucopenia, nausea/vomiting, weight loss, and oral mucositis compared with IMRT combined with chemotherapy. The grades of late adverse reactions of IMRT combined with endostar were not different from those of IMRT combined with chemotherapy.The present study demonstrates that, compared with IMRT combined with chemotherapy, IMRT combined with endostar has similar efficacy in the treatment of locally advanced NPC, but significantly weaker acute adverse reactions, which improve the life quality of NPC patients.
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Affiliation(s)
- Min Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University; Guangxi Tumor Radiation Therapy Clinical Medical Research Center, Nanning
| | - Fangfang Wang
- Department of Radiation Oncology, First People's Hospital of Beihai City, Beihai, Guangxi, PR China
| | - Xueyin Liao
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University; Guangxi Tumor Radiation Therapy Clinical Medical Research Center, Nanning
| | - Pingting Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University; Guangxi Tumor Radiation Therapy Clinical Medical Research Center, Nanning
| | - Rensheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University; Guangxi Tumor Radiation Therapy Clinical Medical Research Center, Nanning
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170
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Liu SL, Tang LQ, Chen QY, Lin HX, Yang Q, Zhu Q, Wen W, Guo SS, Liu LT, Li Y, Xie HJ, Tang QN, Sun XS, Liang YJ, Li XY, Yan JJ, Lin C, Lan XW, Mai HQ, Guo L. The prognosis of neck residue nasopharyngeal carcinoma (NPC) patients: results from a case-cohort study. J Cancer 2018; 9:1765-1772. [PMID: 29805702 PMCID: PMC5968764 DOI: 10.7150/jca.24573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/03/2018] [Indexed: 02/05/2023] Open
Abstract
Background: To assess the prognosis of neck residue nasopharyngeal carcinoma (NPC) patients and the efficacy of neck dissection in the treatment of these patients. Methods: We recruited 68 neck residue NPC patients. For each neck residue patient we had three matched NPC patients without neck residue as controls (n = 204). The primary endpoint was progression-free survival (PFS). The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs), and multivariable analysis was used to test the independent statistical significance of NPC patients. Results: Compared to controls, the neck residue patients showed significantly lower 3-year PFS (46.7% vs. 87.6%; P < 0.001). Multivariable analysis showed that neck residue was an independent prognostic factor for PFS. Conclusions: NPC patients who had pathologically proven neck residue are associated with poor prognosis. Management with neck dissection alone seems not to be sufficient for these patients.
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Affiliation(s)
- Sai-Lan Liu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Qiu-Yan Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Huan-Xin Lin
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine
| | - Qi Yang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Qian Zhu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine
| | - Wen Wen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Shan-Shan Guo
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Li-Ting Liu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Yang Li
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Hao-Jun Xie
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Qing-Nan Tang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Xue-Song Sun
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Yu-Jing Liang
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Xiao-Yun Li
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Jin-Jie Yan
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Chao Lin
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Xiao-Wen Lan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
| | - Ling Guo
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine.,Department of Nasopharyngeal Carcinoma; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University
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Wei YC, Yang SF, Chang SL, Chen TJ, Lee SW, Chen HS, Lin LC, Li CF. Periostin overexpression is associated with worse prognosis in nasopharyngeal carcinoma from endemic area: a cohort study. Onco Targets Ther 2018; 11:3205-3213. [PMID: 29881294 PMCID: PMC5985804 DOI: 10.2147/ott.s163626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose Nasopharyngeal carcinoma (NPC) is a heterogeneous disease. We searched for genes that function in cell adhesion in GSE12452, a published transcriptomic database. We found that POSTN, which encodes periostin (POSTN), was significantly upregulated in NPC tumorigenesis. Herein, we sought to analyze the expression of POSTN and its prognostic significances in patients with NPC. Materials and methods In this single-institution retrospective study, we determined and analyzed POSTN expression by immunohistochemistry and H-score method, respectively, in 124 patients with NPC. The results indicated that POSTN expression was correlated with the clinicopathologic features, disease-specific survival (DSS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS) of NPC. We performed univariate and multivariate analyses to determinate the statistical significance. Results High POSTN expression was significantly associated with lymph node metastasis (p=0.004) and advanced American Joint Committee on Cancer (AJCC) stage (p=0.006). In univariate analysis, high POSTN expression served as a significant prognostic factor for worse DSS (p=0.0002), DMFS (p=0.0138), and LRFS (p=0.0028). In multivariate Cox regression analyses, which was adjusted for AJCC stages, POSTN expression was independently associated with cancer-related death (HR: 2.311; 95% CI: 1.327-4.027; p=0.003) and local tumor recurrence (HR: 3.187; 95% CI: 1.108-4.408; p=0.024). Conclusion High POSTN expression is associated with tumor aggressiveness and worse clinical outcomes in NPC, indicating that it may be a potential prognostic biomarker and a therapeutic target.
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Affiliation(s)
- Yu-Ching Wei
- Department of Pathology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheau-Fang Yang
- Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Lun Chang
- Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Tzu-Ju Chen
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan.,Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Sung-Wei Lee
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Hung-Sung Chen
- Department of Pathology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Li-Ching Lin
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Feng Li
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.,National Institute of Cancer Research, National Health Research Institute, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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van Koevering K, Prevedello DM, Carrau RL. Endoscopic endonasal approaches for the management of cranial base malignancies: histologically guided treatment and clinical outcomes. J Neurosurg Sci 2018; 62:667-681. [PMID: 29808637 DOI: 10.23736/s0390-5616.18.04507-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Malignancies of the skull base represent a highly diverse and challenging set of pathologies which exhibit a wide array of oncologic behavior. In recent decades, a number of important advances in treatment technique have evolved to improve oncologic outcomes and reduce morbidity in the treatment of these aggressive cancers. Intensity modulated radiation therapy has become the gold standard in radiotherapy owing to its precision planning and reduced morbidity. However heavy ion particle radiation (proton therapy, carbon ion, etc.) are recently emerging with promising results at the skull base related to the reduced exit dose to adjacent structures. Novel systemic therapeutics such as targeted and immunotherapies may dramatically alter the treatment paradigm for many of these pathologies. Nevertheless, most skull base malignancies remain surgical diseases. The evolution of the expanded endonasal approach for a minimally invasive surgical resection has proven validity in treating many of these pathologies when properly selected, and have largely supplanted open approaches owing to the reduced morbidity profile. In spite of these important advances, the most critical aspect in comprehensive treatment is a detailed understanding of the oncologic behavior and outcomes data for each of the specific histopathologies encountered at the skull base. The nuances in management strategy, histologic profile, and surveillance planning can be stratified through the development of a comprehensive, multidisciplinary skull base team to maximize therapeutic effect and minimize morbidity for each patient. This review aims to summarize the key body of data and approaches for each of the histologies frequently encountered in the skull base, while highlighting the value and technique of endonasal approaches.
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Affiliation(s)
- Kyle van Koevering
- Department of Otolaryngology, Head and Neck Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA -
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Liang ZG, Lin GX, Ye JX, Li Y, Li L, Qu S, Liang X, Zhu XD. Cetuximab or Nimotuzumab Versus Cisplatin Concurrent with Radiotherapy for Local-Regionally Advanced Nasopharyngeal Carcinoma: a Meta-analysis. Asian Pac J Cancer Prev 2018; 19:1397-1404. [PMID: 29802706 PMCID: PMC6031838 DOI: 10.22034/apjcp.2018.19.5.1397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: It is unclear whether Cetuximab (CTX) or Nimotuzumab (NTZ) concurrent with radiotherapy delivers
equivalent or improved results with fewer toxicities over standard cisplatin (CDDP) concurrent with radiotherapy
in locally advanced nasopharyngeal carcinoma (NPC). Methods: The strategy involved searching the PubMed,
Embase, Cochrane Library, China National Knowledge Internet Web, Wanfang and Chinese Biomedical databases.
Controlled clinical trials that compared concurrent CTX/NTZ with radiotherapy versus CDDP with radiotherapy
in local-regionally advanced NPC were included. Results: In all, 1,239 patients in six clinical trials were included
in the analysis. The hazard ratios (HRs) between the CTX/NTZ and CDDP groups were 1.01 (95% confidence interval
(CI) 0.63-1.64), 1.06 (95% CI 0.50-2.25), 1.04 (95% CI 0.61-1.76), and 1.05 (95% CI 0.73-1.50) for overall survival,
local-regional failure-free survival, distant metastasis failure-free survival, and disease-free survival, respectively.
Significant differences were found in the incidences of grade 3-4 anaemia [Risk ratio (RR) 0.11 95% CI 0.02-0.58], grade
3-4 neutropenia (RR 0.23 95% CI 0.12- 0.44), grade 3-4 thrombocytopenia (RR 0.31 95% CI 0.12- 0.79), and grade
3-4 vomiting (RR 0.04 95% CI 0.00-0.29) in favour of the CTX/NTZ group. However, the patients in the CTX/NTZ
group experienced a higher incidence of grade 3-4 skin rash (RR 6.45 95% CI 3.84-10.84). Conclusions: Regarding
the efficacy and side effects, the combination of CTX / NTZ and radiotherapy may be an alterative treatment regimen
of standard CDDP concurrent with radiotherapy in local-regionally advanced NPC, especially in patients who cannot
tolerate or who refuse chemotherapy.
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Affiliation(s)
- Zhong Guo Liang
- Department of Radiation Oncology, The Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, 71 He Di Road, Nanning 530021, P.R. China
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He J, Wu P, Tang Y, Liu S, Xie C, Luo S, Zeng J, Xu J, Zhao S. Chemoradiotherapy enhanced the efficacy of radiotherapy in nasopharyngeal carcinoma patients: a network meta-analysis. Oncotarget 2018; 8:39782-39794. [PMID: 28418901 PMCID: PMC5503653 DOI: 10.18632/oncotarget.16349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/20/2017] [Indexed: 12/03/2022] Open
Abstract
Object A Bayesian network meta-analysis (NMA) was conducted to estimate the overall survival (OS) and complete response (CR) performance in nasopharyngeal carcinoma (NPC) patients who have been given the treatment of radiotherapy, concurrent chemoradiotherapy (C), adjuvant chemotherapy (A), neoadjuvant chemotherapy (N), concurrent chemoradiotherapy with adjuvant chemotherapy (C+A), concurrent chemoradiotherapy with neoadjuvant chemotherapy (C+N) and neoadjuvant chemotherapy with adjuvant chemotherapy (N+A). Methods Literature search was conducted in electronic databases. Hazard ratios (HRs) accompanied their 95% confidence intervals (95%CIs) or 95% credible intervals (95%CrIs) were applied to measure the relative survival benefit between two comparators. Meanwhile odd ratios (ORs) with their 95% CIs or CrIs were given to present CR data from individual studies. RESULTS Totally 52 qualified studies with 10,081 patients were included in this NMA. In conventional meta-analysis (MA), patients with N+C exhibited an average increase of 9% in the 3-year OS in relation to those with C+A. As for the NMA results, five therapies were associated with a significantly reduced HR when compared with the control group when concerning 5-year OS. C, C+A and N+A also presented a decreased HR compared with A. There was continuity among 1-year, 3-year and 5-year OS status. Cluster analysis suggested that the three chemoradiotherapy appeared to be divided into the most compete group which is located in the upper right corner of the cluster plot. Conclusion In view of survival rate and complete response, the NMA results revealed that C, C+A and C+N showed excellent efficacy. As a result, these 3 therapies were supposed to be considered as the first-line treatment according to this NMA.
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Affiliation(s)
- Jian He
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ping Wu
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yaoyun Tang
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Sulai Liu
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chubo Xie
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shi Luo
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Junfeng Zeng
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Xu
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Suping Zhao
- Department of Otorhinolaryngology Head & Neck Surgery, Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Katano A, Takahashi W, Yamashita H, Yamamoto K, Ando M, Yoshida M, Saito Y, Abe O, Nakagawa K. Radiotherapy alone and with concurrent chemotherapy for nasopharyngeal carcinoma: A retrospective study. Medicine (Baltimore) 2018; 97:e0502. [PMID: 29718841 PMCID: PMC6392595 DOI: 10.1097/md.0000000000010502] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We sought to evaluate clinical outcomes and toxicities of radiation therapy (RT) alone compared to RT with concurrent chemotherapy (CCT) for nasopharyngeal carcinoma (NPC) treatment.We conducted a retrospective review of consecutive patients with biopsy-proven nonmetastatic NPC who underwent RT at our institution. From May 2001 to April 2015; 62 newly diagnosed NPC patients were treated with three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) with or without CCT. The patients were classified as follows: 8% stage I, 15% stage II, 32% stage III, and 45% stage IVA/IVB. A total of 76% of tumors were World Health Organization types II or III. Acute and late toxicities were graded according to the Common Terminology Criteria for Adverse Events version 3.0. Overall survival (OS), progression-free survival (PFS), locoregional progression-free survival (LRPFS), and distant metastasis-free survival (DMFS) were analyzed.The median follow-up period for living patients was 53 months. The median actual delivered dose was 70 Gy with a range of 28 to 70 Gy in fraction sizes of 2 Gy. The estimated 5-year OS, PFS, LRPFS, and DMFS rates were 72.7%, 59.8%, 77.9%, and 84.2%, respectively. The use of CCT was a predictive factor of significantly better OS and PFS, whereas stage IV was a significant predictor of poor OS and PFS. The most severe acute toxicities included Grade 3 mucositis in 56% and Grade 3 dermatitis in 8%. Subset analysis revealed that Grade 2 xerostomia was significantly lower in the IMRT (23%) group than in the 3D-CRT (52%) group (P = .02).RT yielded favorable outcomes. CCT was associated with longer PFS and OS than RT alone.
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Affiliation(s)
- Atsuto Katano
- Department of Radiology, University of Tokyo Hospital
| | | | | | - Kentaro Yamamoto
- Department of Radiology, Japan Self Defense Force Central Hospital
| | - Mizuo Ando
- Department of Otolaryngology—Head and Neck Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Masafumi Yoshida
- Department of Otolaryngology—Head and Neck Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Saito
- Department of Otolaryngology—Head and Neck Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital
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Xu GZ, Li L, Zhu XD. Effect of interrupted time during intensity modulated radiation therapy on survival outcomes in patients with nasopharyngeal cancer. Oncotarget 2018; 8:37817-37825. [PMID: 27911864 PMCID: PMC5514952 DOI: 10.18632/oncotarget.13713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the influence of interrupted time (IT) during intensity-modulated radiotherapy (IMRT) on survival outcomes in patients with nasopharyngeal cancer (NPC). MATERIALS AND METHODS 515 NPC patients receiving IMRT between January 2007 and December 2011 were retrospectively reviewed. The association of IT with loco-regional failure-free survival (LRFS), progression free survival (PFS) and overall survival (OS) was assessed by univariate and multivariate analysis. The Kaplan-Meier methodology was used for survival analyses and the differences among groups were assessed by the log-rank test. The Cox model was used for evaluating the prognostic factors for LRFS, PFS, and OS. RESULTS The 3-year PFS and OS analysis revealed significant difference between patients with a IT >4 days and those with a IT ≤4 days (72.1% vs 81.9%, p <0.05; 80.8% vs 87.9%, p <0.05). Age (≥44 years vs <44 years), T classification, N classification, and IT (>4 days vs ≤4 days) were independent prognostic factors for PFS and OS, respectively (p <0.05). Only N classification acted as the prognostic factor for LRFS (p <0.05). CONCLUSION The IT of more than 4 days during IMRT may affect survival outcomes of NPC patients. We should minimize the interruption of radiotherapy caused by any reason as much as possible.
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Affiliation(s)
- Guo-Zeng Xu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Ling Li
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
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177
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Palazzi M, Guzzo M, Bossi P, Tomatis S, Cerrotta A, Cantú G, Locati LD, Licitra L. Regionally Advanced Nasopharyngeal Carcinoma: Long-Term Outcome after Sequential Chemotherapy and Radiotherapy. TUMORI JOURNAL 2018; 90:60-5. [PMID: 15143974 DOI: 10.1177/030089160409000114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To evaluate the long-term clinical outcome of 61 patients with regionally advanced nasopharyngeal carcinoma treated with sequential chemotherapy and radiotherapy within a phase II trial. Methods The trial evaluated a combined modality regimen including 3 cycles of induction polychemotherapy (epirubicin 70 mg/m2 d1, and cisplatin 100 mg/m2 d1, both recycled every 3 weeks) followed by definitive radiotherapy to the primary site (64–70 Gy) and the neck (50–70 Gy). Patients included in the trial had pathologically confirmed nasopharyngeal carcinoma; stage (UICC 1987) T-any, N2-3, M0; ECOG performance status 0–1. Sixty-one patients were enrolled between 1990 and 1996; stage according to UICC 1997 was IIb in 8%, III in 36% and IV in 56% of the patients; histology was WHO type 1–2 in 11% and WHO type 3 in 89% of cases. Minimum follow-up of 33 surviving patients is 5.2 years. Results Clinical failure has been observed in 30 patients (49%): initial failure, observed within the third year of follow-up in all but one case, was local alone in 6 (20%), regional alone in 10 (33%), local and regional in 1 (3%), regional and distant in 1 (3%), and distant alone in 12 patients (40%). Seven patients received salvage surgery to the neck, 2 of them still disease-free at 10 and 11 years from salvage surgery; 4 patients with an isolated local relapse were re-irradiated, and one of them was alive and well at 6.5 years from salvage radiation. At 5-year local control, regional control and distant metastasis-free rates were 83%, 74% and 73%, respectively; overall and disease-free survival were 64% and 51%. Late effects of initial treatment, as evaluated in 30 patients surviving 5 years without relapse, were generally acceptable, but some degree of xerostomia, dental damage, trismus and hearing loss were reported by a significant proportion of patients (respectively 100%, 88%, 76% and 86%). Conclusions In our experience, long-term clinical cure of regionally advanced nasopharyngeal carcinoma was obtained in 51% of cases treated with chemotherapy and radiotherapy. Salvage treatments (neck surgery, local re-irradiation) are worthy, as they increase the cure rate by approximately 10%, raising 5-year survival to over 60%. Late effects are significant, calling for refinements in radiation technique, better integration with chemotherapy to possibly decrease the need for higher radiation dose, and/or use of effective radioprotectants.
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Affiliation(s)
- Mauro Palazzi
- Department of Radiotherapy, National Cancer Institute, Milan, Italy.
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Wu LR, Zhu HF, Xu J, Jiang XS, Yin L, Jiang N, Zong D, Wang FJ, Huang SF, Bian XH, Wu JF, Song D, Guo WJ, Liu JY, He X. Effectiveness of Cetuximab in Combination with Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma: A 1:2 Propensity Score-matched Analysis. J Cancer 2018; 9:1642-1651. [PMID: 29760803 PMCID: PMC5950594 DOI: 10.7150/jca.23994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/19/2018] [Indexed: 11/27/2022] Open
Abstract
Background: This study aimed to compare concurrent chemoradiotherapy (CCRT) plus cetuximab (C) with CCRT alone in locoregionally advanced nasopharyngeal carcinoma(NPC). Methods: A total of 682 locoregionally advanced NPC patients who had undergone chemoradiotherapy with or without cetuximab were included. Propensity score-matching method was used to match patients. Progression-free survival (PFS), overall survival (OS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared between the two treatment arms. Results: After matching, 225 patients were identified for the analysis. Compared to CCRT, CCRT plus C was associated with significantly improved 3-year PFS (83.7% vs 71.9%, P = 0.036), LRFS (98.6% vs 90.2%, P = 0.034) but not OS (91.4% vs 85.4%, P = 0.117). Among patients with T4 and/or N3 category, CCRT plus C significantly prolonged 3-year PFS (81.0% vs 61.4%, P = 0.022) and increased 3-year OS (88.0% vs 77.9%, P = 0.086). No significant differences were observed between CCRT plus C and CCRT alone groups with regard to 3-year PFS, OS, LRFS and DMFS rates in stage III patients. Acute oral and oropharyngeal mucositis during radiotherapy were more common in the CCRT plus C than that in CCRT, but late toxicities were comparable. Conclusions: This study reveals that patients with locoregionally advanced NPC could benefit from the addition of cetuximab to CCRT, and this therapeutic gain mainly originated from T4 and/or N3 subgroup although suffering more acute moderate to severe toxicities.
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Affiliation(s)
- Li-Rong Wu
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Huan-Feng Zhu
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Jianhua Xu
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Xue-Song Jiang
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Li Yin
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Ning Jiang
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Dan Zong
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Fei-Jiang Wang
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Sheng-Fu Huang
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Xiu-Hua Bian
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Jian-Feng Wu
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Dan Song
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Wen-Jie Guo
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Ju-Ying Liu
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
| | - Xia He
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
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Mnejja W, Toumi N, Fourati N, Bouzguenda R, Ghorbel A, Frikha M, Siala W, Daoud J. [Neoadjuvant chemotherapy with concurrent chemoradiotherapy in the treatment of nasopharyngeal cancer: Southern Tunisian experience]. Bull Cancer 2018; 105:450-457. [PMID: 29650393 DOI: 10.1016/j.bulcan.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 12/09/2022]
Abstract
PURPOSE A retrospective study to evaluate the efficacy and safety of the addition of neoadjuvant chemotherapy to concurrent chemoradiotherapy in the treatment of nasopharyngeal carcinoma. PATIENTS AND METHODS Data from 62 patients treated for non-metastatic nasopharyngeal carcinoma were analyzed by comparing two groups of patients: a first group of 32 patients treated with 3 cycles of neoadjuvant chemotherapy based on docetaxel, cisplatin and 5-fluoro-uracil every 21 days followed by concurrent chemoradiotherapy (weekly cisplatin 40mg/m2 with radiotherapy 70Gy, 2Gy per session, 5 sessions per week) and a second group of 30 patients treated with the same concurrent chemoradiotherapy. RESULTS After a median follow-up of 53.5 months, neoadjuvant chemotherapy showed a significant reduction in the rate of a distant metastatic relapses (3.3% vs. 10%, P=0.03). No significant difference in disease-free survival at 5 years (65.6% vs. 68.8%, P=0.46) or overall survival at 5 years (68.8% vs. 73.3%, P=0.46) was noted between the two groups. Induction chemotherapy was associated with febrile neutropenia of 15.6%. During concurrent chemoradiotherapy, hematological complications were greater in the first chemotherapy group (53% vs. 33%). CONCLUSION Induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil is a safe and effective option in the treatment of nasopharyngeal carcinoma. A better definition of high risk of relapse group would optimize the indications of this chemotherapy in the therapeutic arsenal.
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Affiliation(s)
- Wafa Mnejja
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Nabil Toumi
- CHU Habib Bourguiba, service de carcinologie médicale, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Nejla Fourati
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie.
| | - Racem Bouzguenda
- CHU Habib Bourguiba, service de carcinologie médicale, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Abdelmonem Ghorbel
- CHU Habib Bourguiba, service ORL, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Mounir Frikha
- CHU Habib Bourguiba, service de carcinologie médicale, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Wicem Siala
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
| | - Jamel Daoud
- CHU Habib Bourguiba, service de radiothérapie carcinologique, Bourguiba route El Ain km 1,5, 3000 Sfax, Tunisie
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SAIJOH S, MATSUZUKA T, SATO H, SUZUKI M, IKEDA M, SUZUKI R, NAKAEGAWA Y, OMORI K. Long-term outcomes of alternating chemoradiotherapy in patients with advanced nasopharyngeal cancer: a single-centre experience over the last decade. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:103-108. [PMID: 29967557 PMCID: PMC6028817 DOI: 10.14639/0392-100x-1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/01/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY We assessed the long-term outcomes of alternating chemoradiotherapy (ACRT) using 5-fluorouracil and cisplatin (FP) in 25 patients with stage II or advanced nasopharyngeal cancer treated at our institution between April 1999 and April 2010. Median follow-up duration was 87 months (range 2-189). According to the 2009 TNM classification (UICC), six patients were in stage II, nine in stage III, and 10 in stage IV. Treatment completion, response and five-year survival rates were retrospectively assessed. ACRT was performed with a first course of chemotherapy administered followed by the initial round of radiotherapy (36 Gy). Then, a second course of chemotherapy with additional radiotherapy (20-30 Gy) was administered, followed by a final third course of chemotherapy. For chemotherapy, 5-fluorouracil (5-FU, 800 mg/m2/24 h) was intravenously administered for five days, and cisplatin (CDDP, 50 mg/m2/24 h) was administered on the last two days. Treatment completion rate was 96% (24 of 25 cases), and the response rate was 100% (CR: 24 cases and PR: 1 case). Additionally, the five-year overall survival rate was 89.3%. We have demonstrated that ACRT is an effective regimen to treat nasopharyngeal cancer, revealing higher treatment completion, response, and five-year overall survival rates compared with other combinatorial radiotherapy and chemotherapy treatment regimens.
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Affiliation(s)
- S. SAIJOH
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - T. MATSUZUKA
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - H. SATO
- Department of Radiation Oncology, Fukushima Medical University, Fukushima, Japan
| | - M. SUZUKI
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - M. IKEDA
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - R. SUZUKI
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Y. NAKAEGAWA
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - K. OMORI
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
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Wang F, Jiang C, Ye Z, Sun Q, Liu T, Xu M, Wu P, Shi K, Long B, Fu Z, Jiang Y. Efficacy and Safety of Nimotuzumab Plus Radiotherapy With or Without Cisplatin-Based Chemotherapy in an Elderly Patient Subgroup (Aged 60 and Older) With Nasopharyngeal Carcinoma. Transl Oncol 2018; 11:338-345. [PMID: 29425953 PMCID: PMC5884184 DOI: 10.1016/j.tranon.2018.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study was conducted to assess the efficacy and safety of nimotuzumab combined with radiotherapy (RT) in elderly patients with nasopharyngeal carcinoma. MATERIALS AND METHODS The clinical data of 75 nasopharyngeal carcinoma patients, who were initially treated with nimotuzumab combined with RT, were collected and retrospectively reviewed from December 2008 to April 2014. They were aged 60 to 81 years (median 64 years). The distribution of disease was stage II in 10 (13.3%), stage III in 33 (44.0%), and stage IV in 32 (42.7%). Among these patients, 59 cases received cisplatin-based chemotherapy. Survival outcomes and treatment toxicity were analyzed using IBM SPSS 19.0 software. RESULTS With a median follow-up of 45 months (range, 13-78 months), the estimated 3-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), progression failure-free survival (PFS), and overall survival (OS) rates were 95.6%, 95.5%, 98.6%, 89.7%, and 89.2%, respectively. In the subgroup, 3-year OS rate in the patients with concurrent chemotherapy was 90.5% and 77.4% in patients without concurrent chemotherapy (Log-Rank = 1.795, P = .180). Univariate analysis showed that T stage and clinical stage were correlated with OS. Multivariate analysis indicated that age, T stage and tumor response at the end of treatment were independent prognosticators. Nine patients experienced grade 3 to 4 acute mucositis and 26 patients experienced grade 3-4 leukocytopenia, with no cases of skin rash and infusion reaction. Twelve patients developed mild liver function damage. No serious gastrointestinal or renal toxicities were observed. CONCLUSION The efficacy of combined nimotuzumab with RT in elderly NPC patients was encouraging and the toxicities were accepted. In addition, nimotuzumab provides a better option for elderly patients who cannot be tolerate chemotherapy.
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Affiliation(s)
- Fangzheng Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022, People's Republic of China.
| | - Chuner Jiang
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Zhiming Ye
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Quanquan Sun
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Tongxin Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Min Xu
- Department of Physics, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Peng Wu
- Department of Pathology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Kaiyuan Shi
- Department of Ultrasonography, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Bin Long
- Department of Nuclear Medicine, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Zhenfu Fu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022, People's Republic of China; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022, People's Republic of China
| | - Yangming Jiang
- Department of Didital Earth, Institute of Remote Sensing and Didital Earth, CAS, Beijing, 100101, People's Republic of China.
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182
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Wang D, Zhou J, Zheng J, Zhang J, Chen Y, Li W, Wang R. Predictive value of excision repair cross- complementation group 1 expression in locoregionally advanced nasopharyngeal carcinoma receiving cisplatin-based concurrent chemoradiotherapy. Cancer Biomark 2018; 21:875-881. [PMID: 29439312 DOI: 10.3233/cbm-170817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dong Wang
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Juan Zhou
- Department of Oncology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, Guangdong, China
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Jihua Zheng
- Department of Oncology, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, Guangdong, China
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Jiang Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Yaoming Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Wen Li
- Laboratory of Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
| | - Ruizhi Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
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183
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Zhang Z, Jiang C, Hu L. Low Expression of Excision Repair Cross-complementation Group-1 Protein Predicts Better Outcome in Patients with Locally Advanced Nasopharyngeal Cancer Treated with Concurrent Chemoradiotherapy. TUMORI JOURNAL 2018. [DOI: 10.1177/1578.17218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Zhongxin Zhang
- Department of Oncology, Qilu Hospital, Shandong University, Jinan
- Department of Oncology, Qingdao Municipal Hospital, Qingdao, China
| | - Changqing Jiang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, China
| | - Likuan Hu
- Department of Oncology, Qilu Hospital, Shandong University, Jinan
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184
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Development and validation of a gene expression-based signature to predict distant metastasis in locoregionally advanced nasopharyngeal carcinoma: a retrospective, multicentre, cohort study. Lancet Oncol 2018; 19:382-393. [DOI: 10.1016/s1470-2045(18)30080-9] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
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185
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Prognostic Value of Volume-Based Positron Emission Tomography/Computed Tomography in Nasopharyngeal Carcinoma Patients after Comprehensive Therapy. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:1384281. [PMID: 29681779 PMCID: PMC5841114 DOI: 10.1155/2018/1384281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/14/2017] [Accepted: 12/26/2017] [Indexed: 11/17/2022]
Abstract
Objective We assessed the prognostic value of standardized uptake value (SUV) and volume-based methods including whole-body metabolic tumor volume (WBMTV) and whole-body total lesion glycolysis (WBTLG) using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) of patients with nasopharyngeal carcinoma (NPC) after therapy. Methods A total of 221 posttherapy NPC cases were enrolled, all of whom had undergone PET/CT scanning and follow-up in this retrospective study. The diagnostic results of PET/CT were analyzed and compared with histopathological diagnosis or clinical follow-up. Receiver operator characteristic curves, the Kaplan-Meier method, and the log-rank test were used to assess the optimal cutoff values for WBMTV and WBTLG to identify independent predictors of survival. Results The detection rates of the threshold SUV were 2.5, 20%, and 40%, and SUV background methods were 65.6% (378/576), 80.2% (462/576), 71.5% (412/576), and 90.4% (521/576), respectively (P < 0.005). Patients with a WBMTV < 8.10 and/or a WBTLG < 35.58 had significantly better 5-year overall survival than those above the cutoffs (90.7% versus 51.2%, P < 0.001; 91.7% versus 50.4%, P < 0.001), respectively. Multivariate Cox regression modeling showed both WBTLG (RR, 1.002; P = 0.004) and age (RR, 1.046; P = 0.006) could be used to predict overall survival. WBTLG (RR, 1.003; P < 0.001) may have predictive relevance in estimating disease-free survival. Conclusions SUV volume-based threshold background methodology had a significantly higher detection rate for metastatic lesions. WBTLG could be used as an independent prognostic indicator for posttherapy NPC.
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186
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Induction chemotherapy for the treatment of non-endemic locally advanced nasopharyngeal carcinoma. Oncotarget 2018; 8:6763-6774. [PMID: 28036270 PMCID: PMC5351667 DOI: 10.18632/oncotarget.14279] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background The role of induction chemotherapy is less clear in non-endemic locally advanced nanopharyngeal carcinomas (NPC). Results With a total of 233 eligible patients and a median follow-up of 36 months, 3-year overall survival (OS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease free survival (DFS) were 84.5%, 94.9%, 78.6% and 69.2%, respectively. The overall failure rate was 21.0% and distant metastasis occurred in 17.2% patients. Multivariate analyses showed that retropharyngeal and bilateral neck lymph node metastasis were significant prognostic factors for DFS and OS. Moreover, patients receiving both GP (gemcitabine+cisplatin) and TP (docetaxel+cisplatin) regimes had significantly higher DFS and OS compared with PF (cisplatin+5-FU) regime. GP regimes lead to significantly improved OS than TP/PF in some subgroup of patients. No severe toxicities were observed. Materials and Methods We retrospectively analyzed stage III-IVb NPC patients treated between Jan 2006 and Dec 2014, with induction chemotherapy followed by concurrent chemoradiation (IC-CCRT). Statistical analyses were performed on survival and failure patterns. Conclusions These results suggested IC-CCRT was safe and effective for NPCs from non-endemic region. The choice of induction regimen appeared to affect patient outcomes.
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187
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Lin PJ, Twu CW, Liu YC, Lin TY, Wang WY, Lin JC. Comparison the clinical outcomes with altered versus conventional fractionated radiotherapy plus concurrent chemotherapy for advanced nasopharyngeal carcinoma. Head Neck 2018; 40:1156-1163. [PMID: 29389048 DOI: 10.1002/hed.25084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/09/2017] [Accepted: 12/20/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the long-term survivals between altered fractionated and conventional fractionated radiotherapy with the same concurrent chemoradiotherapy (concurrent CRT) for patients with advanced nasopharyngeal carcinoma (NPC). METHODS We retrospectively reviewed 203 patients with NPC who received radiotherapy (RT) by either a conventional fractionated (70-74 Gy/35-37 fractions/7-8 weeks) or altered fractionated (72-75 Gy/45 fractions/6 weeks) schedule plus the same concurrent CRT. RESULTS The patient characteristics between conventional fractionated and altered fractionated groups showed similar distribution. The 5-year rates of nasopharyngeal failure-free, neck failure-free, and distant metastasis failure-free survival between conventional fractionated and altered fractionated groups were 88% versus 86% (P = .7781), 95% versus 93% (P = .4176), and 76% versus 73% (P = .4029), respectively. The overall survival (OS; 5-year rates were 64% versus 62%; P = .4812) and progression-free survival (PFS; 5-year rates were 67% versus 63%; P = .3829) rates also showed no significant differences. The acute and late toxicities were similar between both groups. CONCLUSION Altered fractionated and conventional fractionated RT achieved similar survival outcome when concurrent CRT strategy was used for advanced NPC.
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Affiliation(s)
- Po-Ju Lin
- Department of Radiation Oncology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Chih-Wen Twu
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chun Liu
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tian-Yun Lin
- Department of Otorhinolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yi Wang
- Department of Nursing, Hung Kuang University, Taichung, Taiwan.,Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jin-Ching Lin
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
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188
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Au K, Ngan RK, Ng AW, Poon DM, Ng W, Yuen K, Lee VH, Tung SY, Chan AT, Sze HC, Cheng AC, Lee AW, Kwong DL, Tam AH. Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong: A report of 3328 patients (HKNPCSG 1301 study). Oral Oncol 2018; 77:16-21. [DOI: 10.1016/j.oraloncology.2017.12.004] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/26/2017] [Accepted: 12/07/2017] [Indexed: 12/09/2022]
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189
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Wang HM, Lin TL, Kuo YC, Li HP, Chang KP, Lin CY, Fan HC, Lin AC, Hsieh CH, Tsang NM, Lee LY, Chan SC, Lui KW, Chang YS, Hsu CL. Correlation between overall survival and differential plasma and tissue tumor marker expression in nasopharyngeal carcinoma patients with different sites of organ metastasis. Oncotarget 2018; 7:53217-53229. [PMID: 27448966 PMCID: PMC5288180 DOI: 10.18632/oncotarget.10676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022] Open
Abstract
Differential overall survival of nasopharyngeal carcinoma (NPC) with different organ site metastases has been documented. Here, we attempted to determine the underlying mechanisms by assessing plasma and tumor tissue markers in relation to patient survival. Pretreatment plasma Epstein-Barr virus (EBV) DNA concentrations, cytokines and tissue macrophages, proliferation and apoptosis markers were determined in 178 patients with metastatic NPC. The median overall survival (OS) was 19 months. Patients with single organ metastases had better outcomes than those with multiple organ metastases (median OS: 26 months vs. 16 months), with statistical significance. Among the single organ involvement cases, patients with lung metastasis only showed longer survival than those with bone or liver involvement (median OS: 50 months vs. 21 months vs. 18 months; P < 0.001). Pretreatment plasma EBV DNA concentrations were lower in patients with lung metastasis than bone or liver metastasis among single organ site groups. Plasma interferon-γ-inducible protein-10 (IP-10) and monocyte chemotactic protein-1 (MCP-1) expression levels were correlated with differential single organ site metastasis OS and EBV DNA load. Liver metastatic tissue had higher density of infiltrating macrophages and proliferative index than the lung metastatic group. Low pretreatment plasma EBV DNA load, expression of cytokines, such as IP-10 and MCP-1, tissue macrophage infiltration, and proliferative index may contribute to the differences in overall survival.
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Affiliation(s)
- Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tung-Liang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yung-Chia Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsin-Pai Li
- Department of Cell and Molecular Biology, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsien-Chi Fan
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - An-Chi Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Sheng-Chieh Chan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kar-Wai Lui
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Sun Chang
- Department of Cell and Molecular Biology, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Cheng-Lung Hsu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
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190
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Muhanna N, Chan H, Qiu J, Daly M, Khan T, Doglietto F, Kucharczyk W, Goldstein DP, Irish JC, de Almeida JR. Volumetric Analysis of Endoscopic and Maxillary Swing Surgical Approaches for Nasopharyngectomy. J Neurol Surg B Skull Base 2018; 79:466-474. [PMID: 30210974 DOI: 10.1055/s-0037-1617432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/10/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives/Hypothesis The endoscopic endonasal approach (EEA) for nasopharyngectomy is an alternative to the maxillary swing approach (MSA) for selected recurrent nasopharyngeal carcinomas (NPC). We compare the access between these approaches. Methods Three cadaver specimens were used to compare access volumes of the EEA and MSA. Exposure volumes were calculated using image guidance registration to cone beam computed tomography and tracking of accessible tissue with volumetric quantification. The area of exposure to the carotid artery was measured. Results The MSA provided higher volumes for access volume compared with the EEA (66.6 vs 39.1 cm 3 , p = 0.009). The working area was larger in the MSA (80.2 vs 56.9 cm 2 , p = 0.06). The exposure to the carotid artery was higher in the MSA (1.88 vs 1.62 cm 2 , p = 0.04). The MSA provided larger volume of exposure for tumors of the parapharyngeal space with exposure below the palate. Conclusions This study suggests that the MSA for nasopharyngectomy provides a larger volume of exposure. However, much of the increased exposure relates to exposure of the parapharyngeal space below the palate. The EEA provides adequate access to superior anatomical structures.
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Affiliation(s)
- Nidal Muhanna
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Harley Chan
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael Daly
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Tahsin Khan
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Francesco Doglietto
- Department of Neurosurgery, University of Brescia, Owensboro, Kentucky 42301, United States
| | - Walter Kucharczyk
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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191
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Wang WY, Lin TY, Twu CW, Tsou HH, Lin PJ, Liu YC, Huang JW, Hsieh HY, Lin JC. Long-term clinical outcome in nasopharyngeal carcinoma patients with post-radiation persistently detectable plasma EBV DNA. Oncotarget 2018; 7:42608-42616. [PMID: 27191654 PMCID: PMC5173160 DOI: 10.18632/oncotarget.9323] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 04/18/2016] [Indexed: 02/04/2023] Open
Abstract
Purpose To investigate the long-term clinical outcome of nasopharyngeal carcinoma (NPC) patients with persistently detectable plasma EBV (pEBV) DNA after curative radiotherapy (RT). Results The post-RT pEBV DNA levels were very lower copy number (median 21, interquartile range 8–206 copies/ml). After long-term follow-up, the relapse rate was 64.8%, the median time to progression 20 months, and 5-year overall survival (OS) 49.6%. Thirty-two of 39 (82.1%) patients with high viral load (≥ 100 copies/ml) developed tumor relapse, whereas 57.0% (49/86) patients with low viral load (< 100 copies/ml) had tumor relapse (P = 0.0065). The 5-year OS rates were 20.5% and 62.9% for patients with viral load ≥ and < 100 copies/ml (median survival, 20 vs. 100 months; P < 0.0001). Patients who received adjuvant chemotherapy (AdjCT) experienced significant reduction in distant failures (66.2% vs. 31.6%; P = 0.0001) but similar locoregional recurrences (P = 0.2337). The 5-year OS rates were 69.4% for patients who received AdjCT compared with 33.2% for those of without AdjCT (median survival, 111 vs. 32 months; P < 0.0001). Methods We screened 931 newly diagnosed NPC patients who finished curative RT and found 125 patients (13.4%) with detectable pEBV DNA one week after RT. The clinical characteristics, treatment modality, subsequent failure patterns and survivals were analyzed. Conclusions NPC patients with persistently detectable pEBV DNA after curative RT have a higher rate of treatment failure and poor survivals. Levels of the post-RT pEBV DNA and administration of AdjCT affect the final outcome significantly.
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Affiliation(s)
- Wen-Yi Wang
- Department of Nursing, Hung Kuang University, Taichung, Taiwan.,Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Tian-Yun Lin
- Department of Otorhinolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Wen Twu
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Hui Tsou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.,Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
| | - Po-Ju Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Chun Liu
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jing-Wen Huang
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - He-Yuan Hsieh
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jin-Ching Lin
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine,School of Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
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192
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Guo SS, Tang LQ, Chen QY, Zhang L, Liu LT, Guo L, Mo HY, Luo DH, Huang PY, Xiang YQ, Sun R, Chen MY, Wang L, Lv X, Zhao C, Guo X, Cao KJ, Qian CN, Zeng MS, Bei JX, Hong MH, Shao JY, Sun Y, Ma J, Mai HQ. Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in stage III-IVb nasopharyngeal carcinoma patients with Epstein-Barr virus DNA ≥4000 copies/ml: a matched study. Oncotarget 2018; 7:29739-48. [PMID: 27105538 PMCID: PMC5045429 DOI: 10.18632/oncotarget.8828] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 03/28/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effects of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in high-risk (stage III-IVb with EBV DNA≥4000 copies/ml) nasopharyngeal carcinoma (NPC) patients are unclear. METHODS A total of 325 high-risk NPC patients treated with IC+CCRT or CCRT alone who were treated with intensity-modulated radiation therapy (IMRT) between March 2007 and March 2013 were included. For each patient in the IC+CCRT group, a matched pair in the CCRT group was matching for: gender, age, T stage, N stage, clinical stage and WHO (World Health Organization) type. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS). RESULTS There were no significant differences in OS, PFS, DMFS, and LRFS between the IC+CCRT (148 patients) and CCRT (177 patients) groups. After matching, 103 paired patients were analyzed, and there were no differences between the IC+CCRT and CCRT groups regarding clinical outcomes. Based on the subgroup analysis of 156 very-high-risk patients (stage N2-3 with EBV DNA ≥4000 copies/ml), the 5-year OS of the IC+CCRT and CCRT groups was 84.3% and 67.5% (P =0.033), respectively. Based on our multivariate analysis, the treatment group was significantly associated with OS (P=0.034; HR0.451, 95%CI 0.216-0.941). CONCLUSIONS IC+CCRT did not improve the clinical outcomes of high-risk NPC patients compared to CCRT alone. However, in very-high-risk patients, IC+CCRT treatment led to increased OS compared to patients received CCRT treatment alone.
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Affiliation(s)
- Shan-Shan Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Qiu-Yan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Lu Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Li-Ting Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ling Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hao-Yuan Mo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Dong-Hua Luo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Pei-Yu Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yan-Qun Xiang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Rui Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ming-Yuan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Lin Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xing Lv
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chong Zhao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiang Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ka-Jia Cao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chao-Nan Qian
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Mu-Shen Zeng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jin-Xin Bei
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ming-Huang Hong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Good Clinical Practice Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jian-Yong Shao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ying Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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193
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Liu YC, Wang WY, Twu CW, Jiang RS, Liang KL, Lin PJ, Lin JW, Lin JC. Comparison Long-term Outcome of Definitive Radiotherapy plus Different Chemotherapy Schedules in Patients with Advanced Nasopharyngeal Carcinoma. Sci Rep 2018; 8:470. [PMID: 29323141 PMCID: PMC5764995 DOI: 10.1038/s41598-017-18713-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 12/15/2017] [Indexed: 11/08/2022] Open
Abstract
Concurrent chemoradiotherapy (CCRT) is the current standard of care for advanced nasopharyngeal carcinoma (NPC). We hypothesize that shifting CCRT to neoadjuvant chemotherapy followed by radiotherapy (NeoCT-RT) is an alternative option. From December 2004 to January 2009, 256 NPC patients with stage II-IVB were treated by either CCRT or NeoCT-RT. All patients received the same dosage and fractionation schedule of RT. After long-term follow-up, 26.8% (34/127) and 23.3% (30/129) of patients who received CCRT and NeoCT-RT respectively, developed a tumor relapse (P = 0.6134). Overall survival (HR = 1.52, 95%CI = 0.91-2.55, P = 0.1532) and progression-free survival (HR = 1.22, 95%CI = 0.75-1.99, P = 0.4215) were similar in both groups. However, acute toxicities during RT period revealed a significant reduction of grade 3/4 vomiting (23% vs. 0%, P < 0.0001), mucositis (55% vs. 16%, P < 0.0001), and neck dermatitis (31% vs. 16%, P = 0.0041) in the NeoCT-RT group, resulting in fewer emergency room visits (10.2% vs. 1.6%, P = 0.0071). Severe treatment-related late toxicity (15% vs. 14%, P = 0.9590) and the occurrence of second malignancy (3.9% vs. 5.4%, P = 0.7887) also showed no differences. We concluded that NeoCT-RT could be an attractive alternative option of CCRT for advanced NPC.
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Affiliation(s)
- Yi-Chun Liu
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Yi Wang
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Chih-Wen Twu
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Rong-San Jiang
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kai-Li Liang
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Ju Lin
- Department of Radiation Oncology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Jing-Wei Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jin-Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan.
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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194
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Liu JQ, Mai WY, Wang SB, Lou YJ, Yan SX, Jin J, Xu WL. Central nervous system leukemia in a patient with concurrent nasopharyngeal carcinoma and acute myeloid leukaemia: A case report. Medicine (Baltimore) 2017; 96:e9199. [PMID: 29384905 PMCID: PMC6393157 DOI: 10.1097/md.0000000000009199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Concurrent case of nasopharyngeal carcinoma (NPC) and acute myeloid leukemia (AML) has not been reported. Here, we report a case of NPC, who was concurrently suffered from AML one mother after the NPC diagnosis. PATIENT CONCERNS The patient was a 45-year-old male who presented with a mass on his right side neck. DIAGNOSES The patient was diagnosed with Epstein-Barr virus negative type-2 non-keratinizing carcinoma with clivus involvement and unilateral metastasis to the cervical lymph node. INTERVENTIONS He was treated with one cycle of cisplatin and 69.76 Gy of concurrent external-beam radiation. OUTCOMES Three months after completion of chemo-radiotherapy, the patient was diagnosed as acute myeloid leukemia, which achieved complete remission after one course induction chemotherapy. Two months later, however, the patient was diagnosed as central nervous system leukemia. He ultimately died of relapsed leukemia. The overall survival of the patient was 10 months. LESSONS The co-occurrence of NPC and AML is rare and prognosis is poor. Radiotherapy in NPC can disrupt the blood-brain barrier, which may contribute to the pathogenesis of central nervous system leukemia. Early alert and prevention of central nervous system leukemia following radiotherapy in NPC patient is recommended.
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Affiliation(s)
- Jun-Qing Liu
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University
| | - Wen-Yuan Mai
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Hematologic Malignancies of Zhejiang Province, Hangzhou
| | - Si-Ben Wang
- Department of Radiation Oncology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Yin-Jun Lou
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Hematologic Malignancies of Zhejiang Province, Hangzhou
| | - Sen-Xiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Hematologic Malignancies of Zhejiang Province, Hangzhou
| | - Wei-Lai Xu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University; Key Laboratory of Hematologic Malignancies of Zhejiang Province, Hangzhou
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195
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Delayed clinical complete response to intensity-modulated radiotherapy in nasopharyngeal carcinoma. Oral Oncol 2017; 75:120-126. [DOI: 10.1016/j.oraloncology.2017.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/11/2017] [Accepted: 10/23/2017] [Indexed: 12/27/2022]
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196
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Mi JL, Zhang B, Pan YF, Su YX, Fan JF, Liao SF, Qin XL, Yao DC, Tang HY, Jiang W. Chemotherapy regimens containing taxanes or fluorouracil in nasopharyngeal carcinoma: Which better? Oral Oncol 2017; 74:34-39. [DOI: 10.1016/j.oraloncology.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 01/11/2023]
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197
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Chen C, Chen T, Huang C, Wang J, Fei Z. Experience of weekly cisplatin concurrent with intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma patients with resistance to neoadjuvant chemotherapy. Medicine (Baltimore) 2017; 96:e8434. [PMID: 29095283 PMCID: PMC5682802 DOI: 10.1097/md.0000000000008434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is highly sensitive to radiotherapy. Locally advanced NPC has a relatively poor prognosis if treated with radiotherapy alone. Several studies have demonstrated that chemoradiotherapy confers survival benefit in locally advanced NPC. However, a small proportion of patients are resistant to chemotherapy based on cisplatin. So, it is important to make a valuable and inexpensive schedule for these patients. After 2 cycles of neoadjuvant chemotherapy that consisted of gemcitabine and cisplatin (80 mg/m, every 3 weeks) or paclitaxel and cisplatin (80 mg/m, every 3 weeks), magnetic resonance imaging (MRI) was used to evaluate efficacy. A total of 13 patients with extensive nodal disease or/and bulky tumors volume were determined with a stable disease (SD) and enrolled in this study. Cisplatin at a dose of 30 mg/m administered weekly concurrent with intensity-modulated radiotherapy (IMRT) was used to treat these patients resistant to neoadjuvant chemotherapy. The efficacy was evaluated by tumor response and the change of tumor volume. After the completion of concurrent chemoradiotherapy (CCRT), the overall tumor response was a complete response (CR) for 4 of 13 (30.8%) patients and partial response (PR) for 9 of 13 (69.2%) patients. The mean primary tumor volume was reduced by 59.7% and 89.8% at the 24th fraction of IMRT and after the completion of IMRT, respectively. The mean nodal volume was reduced by 63.8% and 93.5% at the 24th fraction of IMRT and after completion of IMRT, respectively. The study showed that weekly cisplatin concurrent with IMRT improved the treatment parameters for locally advanced NPC with resistance to neoadjuvant chemotherapy based on cisplatin. It was a valuable and relatively inexpensive schedule to improve the prognosis for these patients.
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Affiliation(s)
- Chuanben Chen
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University
- Provincial Clinical College, Fujian Medical University
| | - Taojun Chen
- Provincial Clinical College, Fujian Medical University
| | | | - Jing Wang
- Provincial Clinical College, Fujian Medical University
| | - Zhaodong Fei
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University
- Provincial Clinical College, Fujian Medical University
- Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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198
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You R, Cao YS, Huang PY, Chen L, Yang Q, Liu YP, Zou X, Zhang YN, Jiang R, Zhang MX, Duan CY, Lin AH, Hong MH, Chen MY. The Changing Therapeutic Role of Chemo-radiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma from Two/Three-Dimensional Radiotherapy to Intensity-Modulated Radiotherapy: A Network Meta-Analysis. Theranostics 2017; 7:4825-4835. [PMID: 29187906 PMCID: PMC5706102 DOI: 10.7150/thno.21815] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/19/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose: We used randomized trials of radiotherapy (RT) with or without chemotherapy in non-metastatic nasopharyngeal carcinoma to investigate the survival benefit of chemoradiotherapy regimens between two/three-dimensional radiotherapy (2D/3D RT) and intensity-modulated radiotherapy (IMRT). Methods: Overall, 27 trials and 7,940 patients were included. Treatments were grouped into seven categories including RT alone, induction chemotherapy (IC) followed by RT (IC-RT), RT followed by adjuvant chemotherapy (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concurrent chemo-radiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). To distinguish between 2D/3D RT and IMRT, three categories in IMRT were newly added, including CRT in IMRT, IC-CRT in IMRT, and CRT-AC in IMRT. The P score was used to rank the treatments. Results: Both fixed- and random-effects frequentist and Bayesian network meta-analysis models were applied, which provided similar results and the same ranking. IC-CRT was the most effective regimen compared with CRT-AC and CRT in the IMRT era for overall survival (OS) (HR, 95% CI, IC-CRT vs. CRT-AC, 0.61 (0.45, 0.82); IC-CRT vs. CRT 0.65 (0.47, 0.91)), progression-free survival (PFS) (0.69 (0.54, 0.88); 0.63 (0.49, 0.80)), and distant metastasis-free survival (DMFS) (0.58 (0.28, 1.21); 0.60 (0.42, 0.85)). CRT-AC achieved the highest survival benefit compared with CRT, and IC-CRT for loco-regional relapse-free survival (LRRFS) (0.44 (0.15, 1.28); 0.72 (0.22, 2.33)). Among these 10 categories, after distinguishing between 2D/3D RT and IMRT, IC-CRT in IMRT ranked first for OS, PFS, and DMFS, and CRT-AC in IMRT ranked first for LRRFS. Conclusion: IC-CRT should be the most suitable regimen for loco-regionally advanced NPC in the IMRT era.
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199
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Chemotherapy use and survival in stage II nasopharyngeal carcinoma. Oncotarget 2017; 8:102573-102580. [PMID: 29254272 PMCID: PMC5731982 DOI: 10.18632/oncotarget.21751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/21/2017] [Indexed: 11/25/2022] Open
Abstract
Although common, the use of chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We therefore conducted a retrospective cohort study to investigate whether chemotherapy confers survival gains to stage II NPC patients. A total of 251 stage II (2010 UICC/AJCC staging system) NPC patients treated between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity-score matching method. The primary endpoint was overall survival (OS). Secondary endpoints were locoregional-free survival (LRFS) and distant metastasis-free survival (DMFS). Our analyses revealed no significant differences in OS, LRFS, or DMFS for stage II NPC patients treated with radiotherapy (RT) alone, concurrent chemoradiotherapy (CCRT), or CCRT + adjuvant chemotherapy (AC). T2N1 (OR = 6.690; 95% CI, 3.091–14.481) and T1N1 (OR = 5.857; 95% CI, 2.278–15.061) patients were more likely to receive CCRT than T2N0 patients. Similarly, both T2N1 (OR = 10.513; 95% CI, 3.439–32.137) and T1N1 (OR = 7.321; 95% CI, 1.978–27.098) patients were more likely to receive CCRT + AC than T2N0 patients. The present matched survival analysis suggests potential overuse of chemotherapy in stage II NPC, as the addition of chemotherapy did not provide a survival benefit in this group of patients.
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200
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Huang WB, Wong STS, Chan JYW. Role of surgery in the treatment of osteoradionecrosis and its complications after radiotherapy for nasopharyngeal carcinoma. Head Neck 2017; 40:369-376. [DOI: 10.1002/hed.24973] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/18/2017] [Accepted: 09/03/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Wen Bo Huang
- Centre for Nasopharyngeal Carcinoma Research; University of Hong Kong Li Ka Shing Faculty of Medicine; Hong Kong SAR China
| | - Stanley Thian Sze Wong
- Centre for Nasopharyngeal Carcinoma Research; University of Hong Kong Li Ka Shing Faculty of Medicine; Hong Kong SAR China
| | - Jimmy Yu Wai Chan
- Centre for Nasopharyngeal Carcinoma Research; University of Hong Kong Li Ka Shing Faculty of Medicine; Hong Kong SAR China
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