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Xiang L, Zheng Y, Ren P, Lin S, Zhang J, Wen Q, He L, Shang C, Wu J. 5-Fluorouracil combined with cisplatin via arterial induction for advanced T-stage nasopharyngeal carcinoma: A 10-year outcome of a phase I/II study. Front Oncol 2022; 12:868070. [PMID: 35965592 PMCID: PMC9364084 DOI: 10.3389/fonc.2022.868070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeCurrently, there is no optimal dose recommendation for a 120-h continuous infusion of 5-fluorouracil via arterial cannulation for advanced T-stage nasopharyngeal carcinoma (NPC). Thus, the aim of this study was to determine the maximum tolerated dose (MDT), along with the efficacy, late adverse events, and 10-year survival outcome of 5-fluorouracil administered continuously for 120 h combined with cisplatin via the superficial temporal artery in patients with advanced T-stage NPC.Materials and MethodsFifty-one patients with histologically confirmed advanced T-stage NPC were eligible for inclusion in this clinical trial. The patients received induction chemotherapy consisting of cisplatin (20 mg/m2/d for 1–5 d) and 5-fluorouracil, administered continuously for 120 h at different dose gradients via a superficial temporal artery. To identify the MTD of 5-fluorouracil infused arterially, we employed a 3 + 3 design during study phase I. The initial dose administered was 200 mg/m2/d, which then was gradually escalated by 50 mg/m2/d until the MTD was reached. Following two cycles of induction chemotherapy, current radical chemoradiotherapy commenced. We assessed the efficacy, survival, toxicity, and quality of life of patients following treatment.ResultsThe overall response (complete response + partial response) rates following induction chemotherapy in the primary mass and lymph nodes were 100% and 100%, respectively. All 51 (100%) patients achieved T-category down-staging after intra-arterial chemotherapy. The MTD was 450 mg/m2/d for 120 h. No late neurological toxicities, such as brain stem injury, temporal lobe necrosis, and spinal cord injury, were observed. The 5- and 10-year overall survival (OS) rates were 78.0% and 71.7%, respectively, with a median OS of 131 months.ConclusionContinuous infusion of 5-fluorouracil combined with cisplatin via the superficial temporal artery showed promising survival benefits and few toxicities in patients with advanced T-stage NPC.
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Affiliation(s)
- Li Xiang
- *Correspondence: JingBo Wu, ; Li Xiang,
| | | | | | | | | | | | | | | | - JingBo Wu
- *Correspondence: JingBo Wu, ; Li Xiang,
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Liquid biopsy tracking during sequential chemo-radiotherapy identifies distinct prognostic phenotypes in nasopharyngeal carcinoma. Nat Commun 2019; 10:3941. [PMID: 31477699 PMCID: PMC6718666 DOI: 10.1038/s41467-019-11853-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023] Open
Abstract
Liquid biopsies have the utility for detecting minimal residual disease in several cancer types. Here, we investigate if liquid biopsy tracking on-treatment informs on tumour phenotypes by longitudinally quantifying circulating Epstein-barr virus (EBV) DNA copy number in 673 nasopharyngeal carcinoma patients undergoing radical induction chemotherapy (IC) and chemo-radiotherapy (CRT). We observe significant inter-patient heterogeneity in viral copy number clearance that is classifiable into eight distinct patterns based on clearance kinetics and bounce occurrence, including a substantial proportion of complete responders (≈30%) to only one IC cycle. Using a supervised statistical clustering of disease relapse risks, we further bin these eight subgroups into four prognostic phenotypes (early responders, intermediate responders, late responders, and treatment resistant) that are correlated with efficacy of chemotherapy intensity. Taken together, we show that real-time monitoring of liquid biopsy response adds prognostic information, and has the potential utility for risk-adapted treatment de-intensification/intensification in nasopharyngeal carcinoma. Liquid biopsies are emerging as a useful method for diagnosis and prognosis in cancer. Here, the authors show the prognostic value of monitoring the level of circulating Epstein-barr virus DNA throughout induction chemotherapy and chemo-radiotherapy and its potential utility for risk-adapted individualised therapy in nasopharyngeal carcinomapatients.
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Liu L, Fei Z, Chen M, Zhao L, Su H, Gu D, Lin B, Cai X, Lu L, Gao M, Ye X, Jin X, Xie C. Induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus volumetric modulated arc therapy alone in the treatment of stage II-IVB nasopharyngeal carcinoma patients: a retrospective controlled study. Radiat Oncol 2018; 13:148. [PMID: 30103765 PMCID: PMC6090803 DOI: 10.1186/s13014-018-1092-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/02/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In the era of intensity-modulated radiotherapy (IMRT), the role of additional concurrent chemotherapy (CC) to radiotherapy (RT) after induction chemotherapy (IC) compared to IC followed by RT alone remains unclear for stage II-IVB nasopharyngeal carcinoma (NPC) patients. The aim of this study was to evaluate the efficacy and toxicities of IC/RT and IC/CCRT in the treatment of NPC with volumetric modulated arc therapy (VMAT). METHODS From January 2012 to March 2016, a total of 217 NPC patients were retrospectively assessed. Of the 217 patients, 139 patients received IC followed by VMAT alone and 78 patients received IC plus CCRT. Overall survival (OS), progression-free survival (PFS) and toxicities were assessed. RESULTS The 5-year OS, PFS rates were 57.5%, 41.8% and 47.8%, 38.4% for the IC/RT and IC/CCRT arms, respectively, without significant difference in survival between the two groups (both p > 0.05). Multivariate analysis indicated that treatment modality (IC/RT vs. IC/CCRT) was not an independent prognostic factor for OS or PFS. Grade 3-4 leukopenia/neutropenia (3.60% vs. 20.51%, p < 0.001), gastrointestinal disorder (nausea/vomiting/diarrhea, 2.16% vs. 41.03%, p < 0.001), mucositis (29.50% vs. 47.44%, p = 0.01) and xerostomia (34.53% vs. 48.72%, p = 0.04) were more frequent in the IC/ CCRT arm than in the IC/RT arm during VMAT. CONCLUSIONS No significant difference in OS and PFS was observed between IC plus VMAT alone and IC/CCRT in the treatment of stage II-IVB NPC patients, however, more side effects were observed in the IC/CCRT arm.
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Affiliation(s)
- Linger Liu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Zhenghua Fei
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Mengfeng Chen
- Department of Oncology Medicine, Yueqing 3rd People’s Hospital, Wenzhou, 325600 China
| | - Lihao Zhao
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Huafang Su
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Dianna Gu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Baochai Lin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Xiaona Cai
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Lihuai Lu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Mengdan Gao
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Xuxue Ye
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Xiance Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
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Yao JJ, Jin YN, Wang SY, Zhang F, Zhou GQ, Zhang WJ, Zhi-Bin, Cheng, Ma J, Qi ZY, Sun Y. The detrimental effects of radiotherapy interruption on local control after concurrent chemoradiotherapy for advanced T-stage nasopharyngeal carcinoma: an observational, prospective analysis. BMC Cancer 2018; 18:740. [PMID: 30012115 PMCID: PMC6048841 DOI: 10.1186/s12885-018-4495-2] [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] [Received: 12/22/2016] [Accepted: 05/09/2018] [Indexed: 02/08/2023] Open
Abstract
Background Previous studies have reported radiotherapy interruption (RTI) is associated with poor local control in two-dimensional radiotherapy (2DRT) era. However, it remains unclear whether RTI still affects local control for advanced T stage (T3–4) in the intensity-modulated radiation therapy (IMRT) era. We aim to evaluate whether RTI affects local control for T3–4 NPC treated with definitive IMRT. Methods In this observational prospective study, 447 T3–4 NPC patients treated with IMRT plus concurrent chemotherapy were included. All patients completed the planned radiotherapy course, and RTI was defined as the actual time taken to finish the prescribed course of radiotherapy minus the planned radiotherapy time. Receiver operating characteristic (ROC) curve was used for determined the cutoff point of RTI. The effects of RTI on local control were analyzed in multivariate analysis. Results At 5 years, the local relapse-free survival (LRFS) and overall survival (OS) rates were 93.7 and 85.7%, respectively. The cutoff RTI for LRFS was 5.5 days by ROC curve. Compared to patients with RTI > 5 days, patients with RTI ≤ 5 days had a significantly lower rate of LRFS (97% vs. 83%; P < 0.001). In multivariate analysis, RTI was a risk factor independently associated with LRFS (HR = 9.64, 95% CI, 4.10–22.65), but not for OS (HR = 1.09, 95% CI, 0.84–1.64). Conclusions The current analysis demonstrates a significant correlation between prolonged RTI and local control in NPC, even when concurrent chemotherapy is used. We consider that attention to RTI seems to be warranted for patients with advanced T-stage NPC in the era of IMRT. Electronic supplementary material The online version of this article (10.1186/s12885-018-4495-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ji-Jin Yao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People's Republic of China.,Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519001, Guangdong Province, China
| | - Ya-Nan Jin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Si-Yang Wang
- Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519001, Guangdong Province, China
| | - Fan Zhang
- Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519001, Guangdong Province, China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Wang-Jian Zhang
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | | | - Cheng
- Department of Radiation Oncology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519001, Guangdong Province, China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Zhen-Yu Qi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People's Republic of China.
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People's Republic of China.
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Toumi N, Ben Kridis W, Mnejja W, Bouzguenda R, Khanfir A, Ghorbel A, Daoud J, Frikha M. TPF induction chemotherapy followed by concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: Long term results of a Tunisian series. Cancer Radiother 2018; 22:216-221. [PMID: 29650387 DOI: 10.1016/j.canrad.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/21/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE We represent in this study the long term results of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by concurrent chemoradiotherapy in Tunisian patients with locally advanced nasopharyngeal carcinoma. The objective of our study is to analyse the efficacy as well as the toxicity of this therapeutic protocol. PATIENTS AND METHODS Between January 2004 and December 2008, 32 patients with locoregional advanced non metastatic disease (T2b or above and/or N1 or above AJCC 2002) were treated in our institution by three cycles of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy every 21 days followed by concurrent chemoradiotherapy. Conventional radiotherapy was delivered using a cobalt 60 machine during 7 weeks with weekly cisplatin (40mg/m2). RESULTS Twenty-nine patients (90%) had presented an objective clinical response in lymph nodes after neoadjuvant chemotherapy, with a complete response in 28%. Acute toxicity of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy was dominated by vomiting (59%), asthenia (40.6%), diarrhea (34.4%) and febrile neutropenia (15.6%). The complete response rate after the end of treatment was around 80%. The 5 years overall survival and disease-free survival were respectively 68.2% and 67.5%. CONCLUSION Our results, in this field of study, are encouraging with acceptable toxicity despite the lack of intensity-modulated radiotherapy technique in our institution during the period of study.
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Affiliation(s)
- N Toumi
- Department of Oncology, Habib-Bourguiba Hospital, Sfax, Tunisia
| | - W Ben Kridis
- Department of Oncology, Habib-Bourguiba Hospital, Sfax, Tunisia.
| | - W Mnejja
- Department of Radiotherapy, Habib-Bourguiba Hospital, Sfax, Tunisia
| | - R Bouzguenda
- Department of Oncology, Habib-Bourguiba Hospital, Sfax, Tunisia
| | - A Khanfir
- Department of Oncology, Habib-Bourguiba Hospital, Sfax, Tunisia
| | - A Ghorbel
- Department of Otorhinolaryngology, Habib-Bourguiba Hospital, Sfax, Tunisia
| | - J Daoud
- Department of Radiotherapy, Habib-Bourguiba Hospital, Sfax, Tunisia
| | - M Frikha
- Department of Oncology, Habib-Bourguiba Hospital, Sfax, Tunisia
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Yang H, Chen X, Lin S, Rong J, Yang M, Wen Q, Shang C, He L, Ren P, Xu S, Zhang J, Liu Q, Pang H, Shi X, Fan J, Sun X, Ma D, Tan B, Zhang T, Zhang L, Hu D, Du X, Zhang Y, Wen S, Zhang X, Wu J. Treatment outcomes after reduction of the target volume of intensity-modulated radiotherapy following induction chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: A prospective, multi-center, randomized clinical trial. Radiother Oncol 2017; 126:37-42. [PMID: 28864073 DOI: 10.1016/j.radonc.2017.07.020] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate whether reducing the target volume of intensity-modulated radiotherapy (IMRT) after induction chemotherapy (IC) improves the quality of life (QOL) in locoregionally advanced nasopharyngeal carcinoma (NPC) without decreasing the local control and survival rate. PATIENTS AND METHODS A total number of 212 NPC patients staged as III-IVb were randomly assigned to group A (n=97) or group B (n=115) in this prospective clinical trial. All patients received IC followed by cisplatin concurrent with IMRT. IMRT was planned using the images of pre-IC in group A and post-IC in group B. RESULTS The dose received by normal tissues in group B was lower than that of group A (P<0.05). The recovery of the dry mouth symptoms in group B was significantly improved than group B. The quality of life (QOL) scores in group B were higher than group A. With a median follow-up of 35months, the 1-year estimated overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS) in group A versus group B were 97.9% vs 97.3%, 90.7% vs 92,2%, 99.0% vs 98.2%, 91.8% vs 94.8%. The 2-year OS, PFS, LRFFS, DMFS in group A versus group B were 93.7% vs 92.9%, 83.4% vs 84.3%, 96.8% vs 95.5%, 86.5% vs 89.5%. The 3-year OS, PFS, LRFFS, DMFS in group A versus group B were 82.3% vs 87%, 74.7% vs 83.4%, 91.8 vs 93.9%, 81.3% vs 88.6%, respectively. CONCLUSION Reducing the IMRT target volume after IC did not reduce the local control and survival rate in locoregionally advanced NPC but the doses received by normal tissues were decreased, and the QOL scores were improved.
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Affiliation(s)
- Hongru Yang
- Chongqing Medical University, China; Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xin Chen
- Department of Oncology, the Second People's Hospital of Yibin, China
| | - Sheng Lin
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinfeng Rong
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China; Department of Oncology, the Second People's Hospital of Yibin, China
| | - Mi Yang
- Department of Oncology, Nanchong Central Hospital, China; Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qinglian Wen
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Changling Shang
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lijia He
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Peirong Ren
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shan Xu
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianwen Zhang
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qiaoli Liu
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiangxiang Shi
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Juan Fan
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoyang Sun
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Daiyuan Ma
- Department of Oncology, the Affiliated Hospital of North Sichuan Medical College, China
| | - Bangxian Tan
- Department of Oncology, the Affiliated Hospital of North Sichuan Medical College, China
| | - Tao Zhang
- Department of Oncology, Chendu Military General Hospital, China
| | - Ling Zhang
- Department of Oncology, Chendu Military General Hospital, China
| | - Defeng Hu
- Department of Oncology, Chendu Military General Hospital, China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, China
| | - Yu Zhang
- Department of Oncology, Mianyang Central Hospital, China
| | - Shiming Wen
- Department of Oncology, Nanchong Central Hospital, China
| | - Xinping Zhang
- Department of Oncology, Nanchong Central Hospital, China
| | - Jingbo Wu
- Chongqing Medical University, China; Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Posterior Cervical lymph Node Metastasis as the Valuable Prognostic Factor for Stage IVA/IVB Nasopharyngeal Carcinoma Treated with Induction Chemotherapy Followed by Concurrent Chemo-Radiotherapy. Int J Biol Markers 2014; 29:e387-94. [DOI: 10.5301/jbm.5000106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/20/2022]
Abstract
Introduction/Aim To evaluate the prognostic properties of retropharyngeal lymph node (RP), posterior cervical lymph node (PCN), and supraclavicular lymph node (SPC), in stage IVA/IVB nasopharyngeal carcinoma (NPC) patients in setting of induction chemotherapy. Methods We performed a retrospective study including 43 patients with stage IVA/IVB NPC (7th AJCC) treated with induction chemotherapy followed by concurrent chemo-radiotherapy. We analyzed prognosis with the multivariate Cox regression model and p-value from the Wald's test, using the backward elimination method (by likelihood ratio test and percent change of coefficient factors). Result Overall, 24 patients (55.8%) were in stage IVA and 19 (44.2%) in stage IVB. After a median follow-up time of 30 months, the 2-year overall survival (OS) was 79.1%, while the 2-year progression free survival (PFS) and distant metastasis free survival (DMFS) were 59.8% and 69.1%, respectively. In multivariate analysis for predicting DMFS, SPC involvement was not statistically significant (HR 3.39; 95% CI 0.76-15.07; p=0.1), whereas RP involvement was statistically significant (HR 5.81; 95% CI 1.08-31.16; p=0.04). Moreover, and more importantly, PCN involvement was the only nodal factor to predict all of DMFS, PFS, and OS (respectively HR 5.57, 95% CI 1.12-27.71, p=0.036; HR 16.05, 95% CI 1.93-133.65, p=0.01; and HR 28.02, 95% CI 2.74-286.22, p=0.005). Discussion PCN involvement is the only independent prognostic factor of stage IVA/IVB NPC patients treated by induction chemotherapy that predicts DMFS and turns this effect to PFS and OS. PCN involvement is a highly accurate predictor for failure of conventional chemo-radiotherapy. Therefore, patients with PCN involvement should be defined at high-risk, as to be investigated for a new staging system.
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Xiang L, Wang Y, Xu BQ, Wu JB, Xia YF. Preliminary results of a phase I/II study of simultaneous boost irradiation radiotherapy for locally advanced nasopharyngeal carcinoma. Asian Pac J Cancer Prev 2014; 14:7569-76. [PMID: 24460335 DOI: 10.7314/apjcp.2013.14.12.7569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this article is to present preliminary results of simultaneous boost irradiation radiotherapy for locally advanced nasopharyngeal carcinoma (NPC). METHODS Fifty-eight patients who underwent simultaneous boost irradiation radiotherapy for NPC in Cancer Center of Sun Yat-sen University between September 2004 and December 2009 were eligible. Acute and late toxicities were scored weekly according to the Radiation Therapy Oncology Group (RTOG) acute and late radiation morbidity scoring schemes. An especial focus was on evidence of post-radiation brain injury. Also quality of life was analysed according to the EORTC (European Organisation for Research and Treatment of Cancer) recommendations. Discrete variables were compared by ?2 test. The Kaplan-Meier method was used to calculate the survival rates and generate survival curves. RESULTS A total of 58 patients with a mean follow-up time of 36 months completed clinical trials.Fifty- seven patients (98.3) achieved complete remission in the primary sites and cervical lymph nodes, with only one patient (1.7%) showing partial remission.The most frequently observed acute toxicities during the concurrent chemoradiotherapy were mucositis and leucopenia. Four patients (6.9%) had RTOG grade 3 mucositis, whereas four patients (6.9%) had grade 3 leucopenia. No patient had grade 4 acute toxicity. Three (5.17%) of the patients exhibited injury to the brain on routine MRI examination, with a median observation of 32 months (range, 25-42months). All of them were RTOG grade 0. The 3-year overall, regional-free and distant metastasis-free survival rates were 85%, 94% and 91%, respectively. CONCLUSION Simultaneous boost irradiation radiotherapy is feasible in patients with locally advanced nasopharyngeal carcinoma. The results showed excellent local control and overall survival, with no significant increase the incidence of radiation brain injury or the extent of damage. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.
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Affiliation(s)
- Li Xiang
- State Key Laboratory of Oncology in South China, Department of Radiation Therapy, Cancer Centre, Sun Yat-Sen University, Guangzhou, Guangdong, China E-mail : ,
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Niu X, Chang X, Gao Y, Hu C, Kong L. Using neoadjuvant chemotherapy and replanning intensity-modulated radiotherapy for nasopharyngeal carcinoma with intracranial invasion to protect critical normal tissue. Radiat Oncol 2013; 8:226. [PMID: 24083351 PMCID: PMC3874595 DOI: 10.1186/1748-717x-8-226] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 09/28/2013] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the feasibility of neoadjuvant chemotherapy and replanning intensity-modulated radiotherapy (IMRT) for intracranial invasion nasopharyngeal carcinoma (NPC). Methods and materials From June 2007 to January 2012, 32 patients with intracranial invasion NPC treated with TPF (docetaxel 75 mg/m2, cisplatin 75 mg/m2, 5-FU 2500 mg/m2 every 3 weeks for 3 cycles) neoadjuvant chemotherapy, and replanning IMRT with concurrent chemotherapy were retrospectively studied. The first IMRT plan for each patient was generated based on the original planning CT scan acquired before the start of treatment. Because of tumor shrinkage during radiotherapy, modified gross tumor volume of primary tumor (GTV-P) and high risk clinical target volume (CTV-H), and a new plan was generated and used to complete the course of IMRT. The DVHs of IMRT plan with or without replanning were compared. Results There weren’t statistically significant differences in the V95, D-mean, D-95, and D-99 to the modified PTVGTV-P and PTVCTV-H with and without replanning IMRT. Replanning reduced the doses to the brain stem, optic nerve, optic chiasm and temporal lobe. Objective responses were 100.0% 3 months after completion of radiotherapy. Acute toxicities were well tolerated, except for the relatively high incidence of neutropenia. The 2-year local control rates and distant-metastasis free survival were 88.2% (95% CI, 72.9% to 100.0%) and 89.6% (95% CI, 75.9% to 100.0%). Conclusion Neoadjuvant chemotherapy and replanning IMRT according to tumor shrinkage during the treatment is essential to ensure safe doses to normal tissues, and produces encouraging outcome for intracranial invasion NPC.
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Affiliation(s)
- Xiaoshuang Niu
- Department of Radiation Oncology, Shanghai Cancer Center of Fudan University, 270 Dong'an Road, Shanghai 200032, China.
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Tan P, Liu Y, Yu C, Su Z, Li G, Zhou X, Huang D, Zhang X, Qiu Y, Tian Y. EphA2 silencing in nasopharyngeal carcinoma leads to decreased proliferation, invasion and increased sensitization to paclitaxel. Oncol Lett 2012; 4:429-434. [PMID: 23741245 DOI: 10.3892/ol.2012.746] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/22/2012] [Indexed: 11/06/2022] Open
Abstract
EphA2 is frequently overexpressed and functionally altered in a variety of human cancers. However, its roles in human nasopharyngeal carcinoma (NPC) remain unclear. To investigate the roles of EphA2 in the development and progression of NPC, we initially evaluated the expression pattern of EphA2 protein in NPC tissues using western blotting and CCK-8 assay. Fluorescence-activated cell sorting analysis and invasion assay were conducted to observe the effects of EphA2 inhibition in vivo. Our results demonstrated that EphA2 was overexpressed in NPC specimens and the expression of EphA2 was significantly associated with T classification, advanced clinical stage and lymph node metastasis. Moreover, human NPC 5-8F cells were infected with lentiviral vector-mediated EphA2-specific shRNA, which resulted in the significant inhibition of cell growth, invasion of 5-8F cells and markedly enhanced the sensitivity of 5-8F cells to the chemotherapeutic agent paclitaxel in vitro. Collectively, our results demonstrate that EphA2 is involved in malignant cell behavior and is a potential therapeutic target in human NPC.
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Affiliation(s)
- Pingqing Tan
- Department of Otolaryngology, Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008 ; Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, Hunan 410008
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If concurrent–adjuvant chemoradiotherapy is beneficial for locoregionally advanced nasopharyngeal carcinoma, would changing the sequence to induction–concurrent achieve better outcome? ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0032-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lee AWM, Tung SY, Chua DTT, Ngan RKC, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GKH, Law SCK, O'Sullivan B, Yau TK, Leung TW, Au JSK, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst 2010; 102:1188-98. [PMID: 20634482 DOI: 10.1093/jnci/djq258] [Citation(s) in RCA: 248] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Current practice of adding concurrent-adjuvant chemotherapy to radiotherapy (CRT) for treating advanced nasopharyngeal carcinoma is based on the Intergroup-0099 Study published in 1998. However, the outcome for the radiotherapy-alone (RT) group in that trial was substantially poorer than those in other trials, and there were no data on late toxicities. Verification of the long-term therapeutic index of this regimen is needed. METHODS Patients with nonkeratinizing nasopharyngeal carcinoma staged T1-4N2-3M0 were randomly assigned to RT (176 patients) or to CRT (172 patients) using cisplatin (100 mg/m(2)) every 3 weeks for three cycles in concurrence with radiotherapy, followed by cisplatin (80 mg/m(2)) plus fluorouracil (1000 mg per m(2) per day for 4 days) every 4 weeks for three cycles. Primary endpoints included overall failure-free rate (FFR) (the time to first failure at any site) and progression-free survival. Secondary endpoints included overall survival, locoregional FFR, distant FFR, and acute and late toxicity rates. All statistical tests were two-sided. RESULTS The two treatment groups were well balanced in all patient characteristics, tumor factors, and radiotherapy parameters. Adding chemotherapy statistically significantly improved the 5-year FFR (CRT vs RT: 67% vs 55%; P = .014) and 5-year progression-free survival (CRT vs RT: 62% vs 53%; P = .035). Cumulative incidence of acute toxicity increased with chemotherapy by 30% (CRT vs RT: 83% vs 53%; P < .001), but the 5-year late toxicity rate did not increase statistically significantly (CRT vs RT: 30% vs 24%; P = .30). Deaths because of disease progression were reduced statistically significantly by 14% (CRT vs RT: 38% vs 24%; P = .008), but 5-year overall survival was similar (CRT vs RT: 68% vs 64%; P = .22; hazard ratio of CRT = 0.81, 95% confidence interval = 0.58 to 1.13) because deaths due to toxicity or incidental causes increased by 7% (CRT vs RT: 1.7% vs 0, and 8.1% vs 3.4%, respectively; P = .015). CONCLUSIONS Adding concurrent-adjuvant chemotherapy statistically significantly reduced failure and cancer-specific deaths when compared with radiotherapy alone. Although there was no statistically significant increase in major late toxicity, increase in noncancer deaths narrowed the resultant gain in overall survival.
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Affiliation(s)
- Anne W M Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China.
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Ponzanelli A, Vigo V, Marcenaro M, Bacigalupo A, Gatteschi B, Ravetti JL, Corvò R, Benasso M. Induction chemotherapy followed by alternating chemo-radiotherapy in non-endemic undifferentiated carcinoma of the nasopharynx: Optimal compliance and promising 4-year results. Oral Oncol 2008; 44:767-74. [DOI: 10.1016/j.oraloncology.2007.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 09/23/2007] [Accepted: 09/24/2007] [Indexed: 11/17/2022]
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Lee AW, Lau KY, Hung WM, Ng WT, Lee MC, Choi CW, Chan CC, Tung R, Cheng PT, Yau TK. Potential improvement of tumor control probability by induction chemotherapy for advanced nasopharyngeal carcinoma. Radiother Oncol 2008; 87:204-10. [DOI: 10.1016/j.radonc.2008.02.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 02/06/2008] [Accepted: 02/06/2008] [Indexed: 11/28/2022]
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