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Raman D, Tay P, Hirpara JL, Liu D, Pervaiz S. TRAIL sensitivity of nasopharyngeal cancer cells involves redox dependent upregulation of TMTC2 and its interaction with membrane caspase-3. Redox Biol 2021; 48:102193. [PMID: 34839142 PMCID: PMC8636823 DOI: 10.1016/j.redox.2021.102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/09/2022] Open
Abstract
AIMS Preferential expression of receptors for TNF-family related apoptosis inducing ligand (TRAIL), DR4 and DR5 makes TRAIL an attractive anti-cancer therapeutic. However, the efficacy of targeting death receptors has not been extensively studied in nasopharyngeal cancer (NPC). Here we investigated TRAIL sensitivity and its underlying mechanism in NPC cell lines, and assessed the potential of TRAIL as a therapeutic option against NPC. RESULTS Using two established NPC cell lines, we report the expression of DR4 and DR5, which respond to TRAIL ligation by triggering efficient Type II apoptosis. Mechanistically, early activation of caspase-3 and its membrane recruitment is identified in NPC cell lines, which is associated with, hitherto unreported, interaction with transmembrane and tetratricopeptide repeat containing 2 (TMTC2) in the lipid raft domains. TMTC2 expression is induced upon exposure to TRAIL and involves intracellular increase in peroxynitrite (ONOO-) production. While ONOO- increase is downstream of caspase-8 activation, it is involved in the upregulation of TMTC2, gene knockdown of which abrogated TRAIL-induced apoptotic execution. Bioinformatics analyses also provide evidence for a strong correlation between TMTC2 and DR4 or caspase-3 as well as a significantly better disease-free survival in patients with high TMTC2 expression. INNOVATION AND CONCLUSION Collectively, redox-dependent execution of NPC cells upon ligation of TRAIL receptors reintroduces the possible therapeutic use of TRAIL in NPC as well as underscores the potential of using TMTC2 as a biomarker of TRAIL sensitivity.
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Affiliation(s)
- Deepika Raman
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Patricia Tay
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Dan Liu
- Integrated Science and Engineering Program (ISEP), NUS Graduate School, National University of Singapore, Singapore
| | - Shazib Pervaiz
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cancer Science Institute, National University of Singapore, Singapore; NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Cancer Institute, National University Health System, Singapore; Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Wu Y, Wei X, Yuan Z, Xu H, Li Y, Li Y, Hu L, Han G, Qian Y, Hu D. Phase II study of induction chemotherapy followed by concurrent chemoradiotherapy with raltitrexed and cisplatin in locally advanced nasopharyngeal carcinoma. Chin J Cancer Res 2020; 32:665-672. [PMID: 33223761 PMCID: PMC7666785 DOI: 10.21147/j.issn.1000-9604.2020.05.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective For locally advanced nasopharyngeal carcinoma (LA-NPC) patients, high incidences of distant metastases and severe treatment related toxicities are the main obstacles needed to be overcome. Raltitrexed, a specific thymidylate synthase inhibitor with a convenient administration schedule, has an acceptable and manageable toxicity, and possesses radio-sensitizing properties. To investigate the efficacy and safety of raltitrexed and cisplatin induction chemotherapy and concurrent chemoradiotherapy (IC+CCRT) in patients with LA-NPC, a phase II clinical study was conducted. Methods Sixty eligible patients with LA-NPC were enrolled into this study. A raltitrexed-cisplatin combination was used as part of an IC+CCRT regimen. Raltitrexed-cisplatin IC was given once every 3 weeks (q3w) for two cycles, followed by raltitrexed-cisplatin based CCRT q3w for two cycles. Intensity-modulated radiotherapy (IMRT) was given for all enrolled patients. Results All patients were included in survival analysis according to the intent-to-treat principle. The objective response rate (ORR) 3 months after treatment was 98%. The 2-year overall survival (OS) rate was 92%. The median relapse-free survival (RFS) time was 30.5 [95% confidence interval (95% CI), 28.4−32.3] months. The 2-year RFS rate was 85%. The 2-year local failure-free survival (LFFS) rate was 97% and the 2-year distant metastasis-free survival (DMFS) rate was 88%. Acute toxicities were mostly grade 2 and 3 reactions in bone marrow suppression, gastrointestinal side effect and oropharyngeal mucositis. Only two patients occurred grade 4 acute toxicities, one was bone marrow suppression and the other was dermatitis radiation. Conclusions The combination of raltitrexed and cisplatin has a comparable efficacy to those in standard first-line therapy.
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Affiliation(s)
- Yuan Wu
- Department of Radiation Oncology
| | | | | | | | | | - Ying Li
- Department of Radiation Oncology
| | - Liu Hu
- Department of Radiation Oncology
| | | | - Yu Qian
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430071, China
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Zhang B, Li MM, Chen WH, Zhao JF, Chen WQ, Dong YH, Gong X, Chen QY, Zhang L, Mo XK, Luo XN, Tian J, Zhang SX. Association of Chemoradiotherapy Regimens and Survival Among Patients With Nasopharyngeal Carcinoma: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1913619. [PMID: 31626318 PMCID: PMC6813597 DOI: 10.1001/jamanetworkopen.2019.13619] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The role of induction chemotherapy (IC) or adjuvant chemotherapy (AC) in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC) remains controversial. OBJECTIVES To update meta-analyses on the association of survival outcomes with IC and AC regimens in patients with locoregionally advanced NPC and assess whether the current evidence is conclusive by a trial sequential analysis (TSA) approach. DATA SOURCES PubMed, Embase, and Web of Science were searched for articles published from inception until June 1, 2019. STUDY SELECTION Randomized clinical trials that assessed the efficacy of radiotherapy with or without chemotherapy among previously untreated patients and patients with nondistant metastatic NPC. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 investigators from each trial independently and synthesized by the 2 investigators. All trial results were combined and analyzed by a fixed- or random-effects model. MAIN OUTCOMES AND MEASURES Overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRFS). RESULTS A total of 8036 patients (median age, 46.5 years; 5872 [73.1%] male) from 28 randomized clinical trials were included in the analysis. Pooled analyses revealed that concurrent chemoradiotherapy (CCRT) was significantly associated with improved OS, PFS, DMFS, and LRFS compared with radiotherapy across all subgroups. The TSA confirmed the treatment outcomes of CCRT compared with radiotherapy. The additional IC regimen was associated with an improvement in OS (hazard ratio [HR], 0.84; 95% CI, 0.74-0.95), PFS (HR, 0.73; 95% CI, 0.64-0.84), DMFS (HR, 0.67; 95% CI, 0.59-0.78), and LRFS (HR, 0.74; 95% CI, 0.64-0.85). These findings were consistent in subgroup analyses of multicenter trials with sample sizes greater than 250, years of survival rate of 5 or greater, median follow-up longer than 5 years, or low risk of bias. However, the additional AC regimen was not associated with a survival benefit in OS (HR, 0.98; 95% CI, 0.78-1.23), PFS (HR, 0.86; 95% CI, 0.70-1.07), DMFS (HR, 0.84; 95% CI, 0.64-1.10), or LRFS (HR, 0.80, 95% CI, 0.59-1.09). The TSA provided sound evidence on the additional benefit of IC but not AC. CONCLUSIONS AND RELEVANCE These data suggest a significant association of survival outcomes with CCRT in patients with locoregionally advanced NPC. The addition of IC instead of AC could achieve survival benefits. The potential therapeutic gain of AC should be explored in the future.
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Affiliation(s)
- Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Min Min Li
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wen Hui Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jian Fu Zhao
- Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wei Qi Chen
- Big Data Decision Institute, Jinan University, Guangzhou, Guangdong, China
| | - Yu Hao Dong
- Department of Catheterization Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiao Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qiu Ying Chen
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Lu Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiao Kai Mo
- Department of Head and Neck Cancer, Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiao Ning Luo
- Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Beijing, China
| | - Shui Xing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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IMRT combined with concurrent chemotherapy plus adjuvant chemotherapy versus IMRT combined with concurrent chemotherapy alone in patients with nasopharyngeal carcinoma. Oncotarget 2018; 8:39683-39694. [PMID: 28147309 PMCID: PMC5503643 DOI: 10.18632/oncotarget.14799] [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: 08/15/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the efficacy of IMRT combined with concurrent chemotherapy followed by adjuvant chemotherapy compared with IMRT combined with concurrent chemotherapy alone in patients with nasopharyngeal carcinoma. Methods From January 2007 to December 2014, we collected 797 staged II-IVb [UICC = Union for International Cancer Control criteria (7th edition)] NPC patients for analysis. After 1:1 matching,we selected 261 cases as the CCRT group, another 261 patients as the CCRT+AC group. Using Kaplan-Meier to calculate the overall survival (OS), locoregional failure-free survival(LFFS), distant metastasis failure-free survival(DMFS). The log-rank test and Cox-proportional hazards model to evaluate the prognostic factors. Results After matching, there were 261 patients in each group. In CCRT+AC group, The 1-,2- and 3- year os rates were a little higher than in CCRT group(99.6% vs 97.9%,97.4% vs 96.2%,93.8% vs 86.9%, P = 0.150). There were no significant difference in 1-,2-,3- year OS, LFFS, DMFS between the two groups. In subgroup analysis, a little higher OS rate in CCRT+AC group for staged III, IV and T4(III:100% vs 100%, 97.6% vs 95.8%, 94.0% vs 84.0%; IV: 99.1% vs 95.4%, 96.3% vs 95.4%, 90.5% vs 79.4%, P = 0.047;T4:99.1% vs 95.2%, 97.1% vs 95.2%, 90.9% vs 78.2%, P = 0.055). No significant difference were observed in OS, LFFS,DMFS between the groups. Conclusion IMRT combined with concurrent chemotherapy followed by adjuvant chemotherapy might improved 1-,2-,3- year of OS. Whether or not add adjuvant chemotherapy it had similar LFFS rate and DMFS rate in patients with nasopharyngeal carcinoma. Locally advanced NPC patients (III, IV and T4)might benefit from the adjuvant chemotherapy.
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Wu M, Ou D, He X, Hu C. Long-term results of a phase II study of gemcitabine and cisplatin chemotherapy combined with intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma. Oral Oncol 2017; 73:118-123. [PMID: 28939063 DOI: 10.1016/j.oraloncology.2017.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 12/01/2022]
Abstract
Objectives To evaluate long-term results of a phase II study of induction and adjuvant gemcitabine and cisplatin (GP) chemotherapy with intensity-modulated radiotherapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC). Materials and methods One hundred and twelve patients (Stage III: 65, IVA-B: 47) with locoregionally advanced NPC were enrolled in this study. All patients received induction chemotherapy consisting of 1000 mg/m2 gemcitabine on day 1 and 8, and cisplatin 25 mg/m2 on day 1–3, every 3 weeks for 2 cycles. Adjuvant chemotherapy for 2 cycles of the same regime was given 28 days after the end of IMRT. The IMRT technique was utilized for all patients. Results In total, 97.3% patients completed 2 cycles of induction chemotherapy. The overall response rate (RR) of cervical lymph nodes was 89.0%. Acute toxicities were mainly grade 1–2 myleosuppression and vomiting. And 83.9% patients completed 2 cycles of adjuvant chemotherapy. All patients finished IMRT with RR at the end of IMRT for nasopharynx, lymph nodes of neck and retropharyngeal area being 99.1%, 97.9% and 97.7%, respectively. The 5-year local control, regional control, distant metastasis-free and overall survival rates were 93.2%, 92.3%, 89.0% and 82.1%, respectively. The 5-year overall survival of stage III and IVA-B were 87.0%, and 75.5%, respectively. The incidence of grade 3–4 acute radiotherapy-related mucositis was 28.6%. Severe late toxicities were uncommon. Conclusion IMRT combined with GP for locoregionally advanced NPC is well tolerated, effective, and convenient, and warrants further studies.
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Affiliation(s)
- Mingyao Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Dan Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China.
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
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Dou H, Hu D, Lam C, Liu Y, Wang X, Zhang W. Retrospective analysis of results of treatment for nasopharyngeal carcinoma in Macao. Chin J Cancer Res 2014; 26:148-58. [PMID: 24826055 DOI: 10.3978/j.issn.1000-9604.2014.03.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/11/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a common malignancy in Southeast Asia, however, a full consensus has not yet been reached as to the value of comprehensive treatment for NPC. This study was designed to evaluate the epidemiological characteristics of NPC and their prognostic value, as well as the long-term efficacy of NPC treatment. PATIENTS AND METHODS A total of 248 patients, with different stages of NPC, were included in this study. RESULTS The 5-year overall survival (OS) rates for patients in stages I, II, III and IV were 90.48%, 76.71%, 76.89% and 33.87%, respectively (P=0.000), while the respective 5-year progression-free survival (PFS) rates were 85.15%, 72.36%, 63.88% and 26.26% (P=0.000). The respective 5-year OS rates, according to stage, for the group that received radiotherapy combined with chemotherapy and for the group that received radiotherapy only were as follows: stages I and II, 81.67% and 79.59% (P=0.753); stage III, 79.91% and 70.38% (P=0.143); stage IV, 35.22% and 0% (P=0.000). The respective 5-year PFS rates in these groups were as follows: stages I and II, 75.83% and 74.98% (P=0.814); stage III, 74.08% and 42.25% (P=0.027); stage IV, 27.31% and 0% (P=0.000). CONCLUSIONS Clinical staging appears to be the most important prognostic factor for NPC. As the stage number increases, both the 5-year OS and PFS significantly decrease. Adding chemotherapy to radiotherapy was not advantageous for patients with stage I or II NPC, however the addition of chemotherapy to radiotherapy significantly improved OS and PFS in patients with stage IV NPC. The addition of chemotherapy improved PFS, but not OS in patients with stage III NPC.
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Affiliation(s)
- Huiqin Dou
- 1 Department of Stomatology, 2 Department of Clinical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China ; 3 Department of Clinical Oncology, Conde S. Januario General Hospital, Macao, China
| | - Dongyan Hu
- 1 Department of Stomatology, 2 Department of Clinical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China ; 3 Department of Clinical Oncology, Conde S. Januario General Hospital, Macao, China
| | - Chileong Lam
- 1 Department of Stomatology, 2 Department of Clinical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China ; 3 Department of Clinical Oncology, Conde S. Januario General Hospital, Macao, China
| | - Yunsheng Liu
- 1 Department of Stomatology, 2 Department of Clinical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China ; 3 Department of Clinical Oncology, Conde S. Januario General Hospital, Macao, China
| | - Xiuwen Wang
- 1 Department of Stomatology, 2 Department of Clinical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China ; 3 Department of Clinical Oncology, Conde S. Januario General Hospital, Macao, China
| | - Wendong Zhang
- 1 Department of Stomatology, 2 Department of Clinical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China ; 3 Department of Clinical Oncology, Conde S. Januario General Hospital, Macao, China
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Zhang W, Dou H, Lam C, Liu J, Zhou J, Liu Y, Wang X. Concurrent chemoradiotherapy with or without adjuvant chemotherapy in intermediate and locoregionally advanced nasopharyngeal carcinoma. Tumour Biol 2013; 34:1729-36. [PMID: 23436047 DOI: 10.1007/s13277-013-0710-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 02/13/2013] [Indexed: 11/26/2022] Open
Abstract
Concurrent chemoradiotherapy (CCRT) showed a significant improvement in disease control and clinical outcome in patients with intermediate and locoregionally advanced nasopharyngeal carcinoma (NPC) (stage II, III and IVA+B). However, there has been debate about the contribution and application of additional adjuvant chemotherapy (AC) to a CCRT regime. This study aims to evaluate the additional value of AC in the treatment of intermediate and locally advanced NPC with regard to toxicity and clinical outcomes. A total of 189 patients with American Joint Committee on Cancer (AJCC) stage II to stage IVB NPC were retrospectively identified. Patient characteristics, toxicity, compliance with treatment and clinical outcomes, including response to treatment, overall survival (OS), progression-free survival (PFS), relapse-free survival (RFS), freedom from local recurrence (FLR) and freedom from distant metastasis (FDM), were analyzed. The overall response rate of CCRT and CCRT/AC groups was 97.92 % and 97.83 %, respectively (P=0.643). The 5-year OS rate was 68.2 % in the CCRT group and 75.9 % in the CCRT/AC group (P=0.53). The 5-year PFS rate was 66.7 % and 71.4 % in CCRT and CCRT/AC groups, respectively (P=0.96). This study showed no evidence of an additional value of AC in CCRT treatment in disease control and clinical outcomes in patients with locally advanced NPC in endemic regions. Moreover, three additional cycles of AC after CCRT appeared to be poorly tolerated in patients. Therefore, AC should not be routinely used for treatment, although clinical trials may be justified.
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Affiliation(s)
- Wendong Zhang
- Department of Clinical Oncology, Qilu Hospital of Shandong University, 107# Wenhua Xi Road, Jinan, 250012, China
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Perri F, Bosso D, Buonerba C, Lorenzo GD, Scarpati GDV. Locally advanced nasopharyngeal carcinoma: Current and emerging treatment strategies. World J Clin Oncol 2011; 2:377-83. [PMID: 22171280 PMCID: PMC3235656 DOI: 10.5306/wjco.v2.i12.377] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/15/2011] [Accepted: 10/22/2011] [Indexed: 02/06/2023] Open
Abstract
Although nasopharyngeal carcinoma (NPC) is a widespread malignant tumor, it is particularly frequent in Southeast Asia. Although T1 tumors can be effectively controlled with exclusive radiotherapy, this treatment modality is insufficient for most NPC patients, who present with locally advanced disease at diagnosis. In fact, for stages ranging from T2b N0 to T4 N3, definitive scientific evidence supports the use of concurrent platinum-based chemotherapy with standard external beam radiotherapy. This treatment approach has shown a statistically significant advantage in terms of overall survival, with respect to radiotherapy alone. Several trials have also investigated the use of neoadjuvant and adjuvant chemotherapy in combination with radiotherapy or chemo-radiotherapy. Platinum compounds, anthracyclines and taxanes are among the chemotherapy agents employed. This review focuses on the clinical results obtained in the field of adjuvant/concurrent/neoadjuvant chemotherapy for locally advanced NPC, for which exclusive concurrent chemo-radiotherapy currently represents the standard treatment approach.
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Affiliation(s)
- Francesco Perri
- Francesco Perri, Oncology Division, Division INT Fondazione "G. Pascale", 80131 Naples, Italy
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Ren G, Du L, Ma L, Feng LC, Zhou GX, Qu BL, Xu SP, Xie CB, Ou GM, Li F, Zhang XX, Yang J. Clinical observation of 73 nasopharyngeal carcinoma patients treated by helical tomotherapy: the China experience. Technol Cancer Res Treat 2011; 10:259-66. [PMID: 21517132 DOI: 10.7785/tcrt.2012.500201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The preliminary short-term clinical outcome of 73 nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy at our cancer institute has been evaluated. Between September 2007 and September 2009, 73 newly diagnosed NPC patients were treated with helical tomotherapy. The distributions of clinical stages according to the UICC 2002 Staging System were: 6, 27, 24, and 16 for Stage I, IIa-b, III, and IVa-b, respectively. The prescription dose was 70-74 Gy/33F to planning gross tumor volume containing the primary tumor and positive lymph nodes, with 60-62.7 Gy/33F to high risk planning target volume, while delivering 52-56 Gy/33F to low risk planning target volume. Twenty-four patients were treated with radiation therapy as single modality, 25 with concurrent cisplatin-based chemotherapy with or without anti-EGFR monoclonal antibody therapy, and 24 with concurrent anti-EGFR monoclonal antibody therapy. Setup errors were analyzed. Side-effects were evaluated with the established RTOG/EORTC criteria. Average beam-on-time was 468.8 sec/F (396.7-696.1 sec). The setup errors in the lateral, longitudinal and vertical directions were 0.00 ± 1.79 mm, -0.55± 2.17 mm and 0.38 ± 1.43 mm, corresponding to 3.80 mm, 4.20 mm, and 2.46 mm as the CTV-PTV margin in these directions. The grade 0, 1, 2 and 3 acute skin toxicity was 2.7%, 76.7%, 13.8% and 6.8%; the grade 0, 1, 2 and 3 acute mucositis was 1.4%, 32.9%, 60.2% and 5.5%; and the grade 0, 1, 2 and 3 acute xerostomia was 4.0%, 45.3%, 50.7% and 0, respectively. Only 5 patients suffered from grade 3 or 4 leucopenia. Xerostomia resolved with passing of time and no grade 2 or more xerostomia was noted one year after radiation therapy. Concurrent chemotherapy significantly increased incidence of severe acute toxicities. One month after radiation therapy the remission rates of primary tumor and positive lymph nodes were 91.8% and 98.1%, respectively. The median follow-up was 14.8 months. The one-year relapse-free survival, distant metastasis-free survival and overall survival was 95.6%, 97.2% and 94.8%, respectively. In conclusion, the incidence of severe acute toxicities and late xerostomia was relatively infrequent for NPC patients treated with helical tomotherapy. The long-term clinical outcome for these patients is under investigation.
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Affiliation(s)
- G Ren
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing 100853, China.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:138-41. [PMID: 21637039 DOI: 10.1097/moo.0b013e328345326d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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