1
|
Fu S, Li Y, Han Y, Wang H, Chen Y, Yan O, He Q, Ma H, Liu L, Liu F. Diffusion-weighted MRI-guided dose painting in patients with locoregionally advanced nasopharyngeal carcinoma treated with induction chemotherapy plus concurrent chemoradiotherapy: a randomized, controlled clinical trial. Int J Radiat Oncol Biol Phys 2022; 113:101-113. [PMID: 35074433 DOI: 10.1016/j.ijrobp.2021.12.175] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
PURPOSES We hypothesized that diffusion-weighted MRI (DWI)-guided dose-painting intensity modulated radiation therapy (DP-IMRT) is associated with improved local tumor control and survival in locoregionally advanced nasopharyngeal carcinoma (NPC). The purpose of this randomized study was to compare the efficacy and toxicity of DWI-guided DP-IMRT to conventional MRI-based IMRT in locoregional advanced NPC. METHODS A total of 260 NPC patients with stage III-IVa disease were randomly assigned in a 1:1 ratio to receive induction chemotherapy followed by chemoradiotherapy by DWI-guided DP-IMRT (group A, n = 130) or conventional MRI-based IMRT (group B, n = 130) in this prospective clinical trial. In group A, subvolume GTVnx-DWI (gross tumor volume of nasopharynx in DWI) was defined as the areas within the GTVnx (gross tumor volume of nasopharynx) with an apparent diffusion coefficient (ADC) below the mean ADC (ADC < mean) according to MRI before induction chemotherapy. The dose to GTVnx-DWI was escalated to 75.2 Gy/32 Fx in patients with T1-2 disease and to 77.55 Gy/33 Fx in those with T3-4 disease in 2.35 Gy per fraction. In group B, PGTVnx was irradiated at 70.4-72.6 Gy/32-33 Fx in 2.2 Gy per fraction. This trial is registered with chictr.org.cn (number). RESULTS A total of 260 patients were included in the trial (130 patients in group A and 130 in group B). Complete response rates after chemoradiotherapy were 99.2% (129/130) and 93.8% (122/130) in groups A and B, respectively (P=0.042). At a median follow-up of 25 months, DWI-guided DP-IMRT was associated with improved 2-year disease-free survival (DFS, 93.6% [95% CI, 88.1% to 99.1%] vs. 87.5% [95% CI, 81.4% to 93.6%], P = 0.015), local recurrence-free survival (LRFS, 100% [95% CI, not applicable (NA)] vs. 91.3% [95% CI, 85.4% to 97.2%]), locoregional recurrence-free survival (LRRFS, 95.8% [95% CI, NA] vs. 91.3% [95% CI, 85.4% to 97.2%]), distant metastasis-free survival (DMFS, 97.8% [95% CI, NA] vs. 90.9% [95% CI, 85.8% to 96.0%]), and overall survival (OS, 100% [95% CI, NA] vs. 94.5% [95% CI, 89.2% to 99.8%]). There were 0 and 3 patients had local-only recurrences in group A and B, respectively. The most common site of first failure in each arm was distant organ failure. No statistically significant differences in acute and late toxic effects were observed. Multivariate analyses showed that dose painting (DWI-guided DP-IMRT vs conventional MRI-based IMRT without DP) was associated with DFS, LRFS, LRRFS and DMFS. EBV DNA level was associated with DFS and LRRFS. CONCLUSIONS DWI-guided DP-IMRT plus chemotherapy is associated with a disease-free survival benefit compared with conventional MRI-based IMRT among patients with locoregionally advanced NPC without increasing acute toxicity.
Collapse
Affiliation(s)
- Shengnan Fu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yanxian Li
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yaqian Han
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Hui Wang
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China; Key Laboratory of Translational Radiation Oncology, Hunan Province, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yanzhu Chen
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Ouying Yan
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Qian He
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Hongzhi Ma
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Lin Liu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Feng Liu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
| |
Collapse
|
2
|
Morbidity in Patients with Nasopharyngeal Carcinoma and Radiation-Induced Skin Lesions: Cause, Risk Factors, and Dermatitis Evolution and Severity. Adv Skin Wound Care 2021; 34:1-8. [PMID: 34807900 DOI: 10.1097/01.asw.0000797952.41753.f4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Radiation-induced skin injuries such as lesions (RSLs) and dermatitis are the most common complication during radiotherapy (RT) for nasopharyngeal carcinoma, but little is known about risk factors unique to oncology. This study sought a greater understanding of these risk factors to stratify patients based on risk and guide clinical decision-making. METHODS Investigators analyzed the data of 864 consecutive patients referred to the RT center of the Southern Theater General Hospital for a new RSL from 2013 to 2019. These patients were followed up for an average of approximately 16 months until their death or March 30, 2020, whichever came first. Multivariate logistic regression analysis and Cox proportional hazards model were used to identify predictors of grade 3 or 4 dermatitis. RESULTS The main causes of treatment interruption included dermatitis and oral mucositis. Significant patient-specific risk factors for RSLs included current smoking, current drinking, and lower Karnofsky Performance Scale score and significant procedure-specific risk factors included receiving intensity-modulated radiation therapy (IMRT), hyperfractionated RT, induction chemotherapy, multicycle chemotherapy, and taxol- and cisplatin-based drugs. The three factors that independently predicted risk of RSL were IMRT, lower Karnofsky Performance Scale score, and multicycle chemotherapy. Comparing predictive factors among patients with severe RSL revealed that patients who received IMRT were more likely to develop grade 3 or 4 dermatitis. CONCLUSIONS Oncology providers should note that IMRT is an aggressive technique with a trend toward increased RSL. Providers should pay special attention to adverse effects to skin in patients with nasopharyngeal carcinoma.
Collapse
|
3
|
Radiation-induced acute injury of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy in induction chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a prospective cohort study. Sci Rep 2021; 11:7693. [PMID: 33833301 PMCID: PMC8032760 DOI: 10.1038/s41598-021-87170-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/22/2021] [Indexed: 11/26/2022] Open
Abstract
To address whether the addition of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) aggravate radiation-induced acute injury of locoregionally advanced nasopharyngeal carcinoma (LANPC) patients with induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT). We conducted a prospective study of 182 patients in the stage III to IVb with biopsy-proven nonmetastatic LANPC who newly underwent radiotherapy and sequentially received IC, followed by CCRT at our institution. Occurring time of radiation-induced toxicities were estimated and compared using the Kaplan–Meier method and Log-rank test. The most severe acute toxicities included oral mucositis in 97.25% and dermatitis in 90.11%. Subset analysis revealed that Grade 3–4 acute dermatitis were significantly higher in the IMRT than 3D-CRT. Oral mucositis and dermatitis were the earliest occurrence of acute injuries (2 years: 60.44% and 17.58%). Patients in IMRT group achieved significantly lower risk of bone marrow toxicity, but higher risk of leukopenia and gastrointestinal injury. Multivariate analyses also demonstrated that IMRT, female gender and hepatitis were the independent prognostic factors for bone marrow toxicity. In a combined regimen of IC followed by CCRT for the treatment of LANPC, IMRT seems to be an aggressive technique with a trend towards increased gastrointestinal and hematological toxicities, but decreased bone marrow toxicity than those treated with 3D-CRT. This study provides a comprehensive summary of prospective evidence reporting the side effects in the management of LANPC patients. We quantify the occurrence risks of chemoradiotherapy-induced acute injuries through analysis of time-to-event.
Collapse
|
4
|
Guan H, He Y, Su Y, Wei Z, Liu Z, Wang J, He L, Mu X, Li R, Hu X, Peng X. Assessment of different induction chemotherapy regimens in locally advanced nasopharyngeal carcinoma: Meta-analysis. Head Neck 2021; 43:2332-2341. [PMID: 33792110 DOI: 10.1002/hed.26699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A Bayesian network meta-analysis was performed to compare the efficacy and toxicities among different induction chemotherapy regimens in locally advanced nasopharyngeal carcinoma (LA-NPC). METHODS Electronic databases were searched for literature up to September 16, 2019. Two researchers independently selected the articles, evaluated the quality of the literature, and extracted and analyzed the data. RESULTS There were no significant differences in survival outcomes, mucositis, or gastrointestinal adverse events among the four regimens. The probability of GP being the best induction scheme to improve OS was 43.7%. The completion rate of concurrent chemotherapy with the GP regimen was significantly reduced than the other three regimens. CONCLUSIONS The survival outcomes of the four regimens in LA-NPC were comparable. Considering only OS, GP showed the highest probability of improving the survival of LA-NPC, while it also affected the completion of concurrent chemotherapy.
Collapse
Affiliation(s)
- Hui Guan
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yonglin Su
- West China Hospital, Sichuan University, Chengdu, China
| | - Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Mu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruidan Li
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Guan H, He Y, Wei Z, Wang J, He L, Mu X, Peng X. Assessment of induction chemotherapy regimen TPF vs GP followed by concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma: A retrospective cohort study of 160 patients. Clin Otolaryngol 2019; 45:274-279. [PMID: 31788988 DOI: 10.1111/coa.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/21/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Hui Guan
- The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan He
- The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhigong Wei
- The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jingjing Wang
- The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ling He
- The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Mu
- The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xingchen Peng
- The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Tan TH, Soon YY, Cheo T, Ho F, Wong LC, Tey J, Tham IWK. Induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation: A systematic review and meta-analysis. Radiother Oncol 2018; 129:10-17. [PMID: 29555182 DOI: 10.1016/j.radonc.2018.02.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/15/2018] [Accepted: 02/23/2018] [Indexed: 12/09/2022]
Abstract
PURPOSE To determine if the addition of induction chemotherapy (IC) to concurrent chemoradiation (CCRT) in locally advanced nasopharyngeal carcinoma (LA-NPC) can improve survival. METHODS We performed a meta-analysis of both randomized controlled trials (RCTs) and observational studies (OBS) to compare the effects of addition of IC to CCRT versus (vs) CCRT alone on overall survival (OS), progression free survival (PFS), distant metastasis-free survival (DMFS) and adverse events (AE) in LA-NPC. We searched MEDLINE for eligible studies comparing IC plus CCRT vs CCRT for LA-NPC from Jan 1996 to May 2017. We selected RCTs and OBS that included patients with non-metastatic, LA-NPC who received IC followed by CCRT or CCRT alone. Three reviewers independently assessed the abstracts for eligibility. We assessed the methodological quality of the included studies using the MERGE criteria. We performed the meta-analysis with random effects model. We used the GRADE approach to appraise the quality of evidence from RCTs. The primary outcome was OS; secondary outcomes included PFS, DMFS and AE. RESULTS We found six RCTs and five OBS including 2802 patients with low to moderate risk of bias in their methodological quality. There was high quality evidence from the RCTs that IC improved PFS (HR 0.69, 95% CI 0.57-0.84, P = 0.0003, I2 = 0%) and OS (HR 0.77, 95% CI 0.60-0.98, P = 0.03, I2 = 0%) significantly and was associated with more frequent AE. The estimates of IC effects from RCTs and OBS were similar (PFS HR 0.69 vs 0.71, interaction P (IP) = 0.92; OS HR 0.77 vs 0.58, IP = 0.27). CONCLUSIONS IC delays disease progression and improves survival significantly for LA-NPC treated with CCRT, and was associated with more toxicity. There were no divergent results between RCTs and OBS. IC followed by CCRT can be considered one of the standard treatment options for LA-NPC.
Collapse
Affiliation(s)
- Teng Hwee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore National University Hospital, National University of Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore National University Hospital, National University of Singapore, Singapore
| | - Timothy Cheo
- Department of Radiation Oncology, National University Cancer Institute, Singapore National University Hospital, National University of Singapore, Singapore.
| | - Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore National University Hospital, National University of Singapore, Singapore
| | - Lea Choung Wong
- Department of Radiation Oncology, National University Cancer Institute, Singapore National University Hospital, National University of Singapore, Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore National University Hospital, National University of Singapore, Singapore
| | - Ivan W K Tham
- Department of Radiation Oncology, National University Cancer Institute, Singapore National University Hospital, National University of Singapore, Singapore
| |
Collapse
|