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Koide Y, Kodaira T, Kitayama M, Kawakita D, Kirita T, Yoshimoto S, Nakamizo M, Nibu KI. Definitive radiotherapy for nasopharyngeal carcinoma in Japan: analysis of cases in the National Head and Neck Cancer Registry from 2011 to 2014. Jpn J Clin Oncol 2024; 54:54-61. [PMID: 37781753 DOI: 10.1093/jjco/hyad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the nationwide prognosis of patients with nasopharyngeal carcinoma who underwent definitive radiotherapy in Japan, utilizing the National Head and Neck Cancer Registry data. METHODS A total of 741 patients diagnosed with primary nasopharyngeal carcinoma were screened from 2011 to 2014. The inclusion criteria were histologically proven nasopharyngeal squamous cell carcinoma, receiving definitive radiotherapy, and no distant metastases. Patients with unclear prognoses or unknown staging were excluded. The primary endpoint was 5-year overall survival, and secondary endpoints were 5-year progression-free survival and survival by stage. RESULTS A total of 457 patients met the inclusion criteria. The median age was 60 years, and 80% were male. The proportions of patients with performance status 0, 1, 2 and 3 were 69, 10, 1 and 1%, respectively. Chemoradiotherapy was administered to 84.7%. Radiotherapy modalities were recorded only for 29 patients (three received intensity-modulated radiotherapy and 26 received two/three-dimensional radiotherapy). Of those included, 7.4, 24.7, 35.7, 24.5 and 7.7% had Stage I, II, III, IVA and IVB disease, respectively. The 5-year overall survival was 72.5% for all patients: 82.6, 86.6, 76.0, 51.4 and 66.5% for Stage I, II, III, IVA and IVB disease, respectively. The 5-year progression-free survival was 58.6%: 75.6, 66.8, 61.5, 43.7 and 46.5% for Stage I, II, III, IVA and IVB disease, respectively. CONCLUSIONS This nationwide survey demonstrated favorable prognoses and provided valuable foundational data for similar future surveys to monitor the penetration of appropriate treatment and changes in clinical structures based on new evidence.
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Affiliation(s)
- Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
| | - Megumi Kitayama
- Clinical Study Support Center, Data Center Department, Wakayama Medical University Hospital, Wakayama, Japan
| | - Daisuke Kawakita
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadaaki Kirita
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Seiichi Yoshimoto
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Munenaga Nakamizo
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken-Ichi Nibu
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otolaryngology, Kobe University School of Medicine, Kobe, Hyogo, Japan
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Ohara K, Takahara M, Kumai T, Yamashina M, Kishibe K, Katada A, Hayashi T. Treatment outcomes of alternating chemoradiotherapy for nasopharyngeal carcinoma: a single-center safety and efficacy study. Braz J Otorhinolaryngol 2022; 89:440-446. [PMID: 36682990 PMCID: PMC10164767 DOI: 10.1016/j.bjorl.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of Alternating Chemoradiotherapy (ACRT) using cisplatin and 5-Fluorouracil (5-FU) in patients with nasopharyngeal carcinoma. METHODS This was a retrospective study in which patients' clinical records were reviewed to identify patients with a new diagnosis of nasopharyngeal carcinoma at our institution between January 2005 and January 2019. Thirty-seven eligible patients were identified; of these, the clinical details of 27 patients treated with ACRT were evaluated. Patient outcomes, including overall survival and progression-free survival, and adverse events were assessed. RESULTS Of these initial 37 patients, 1, 10, 13, 10, and 3 were staged as I, II, III, IVA, and IVB, respectively, as defined by the 8th edition of the TNM classification system. Twenty-seven patients received ACRT comprising sequential administration of chemotherapy, radiotherapy (wide field), chemotherapy, radiotherapy (shrinking field), and chemotherapy. The 5-year overall survival and progression-free survival rates were 83.7% and 88.9%, respectively. Treatment compliance was 93%, which is comparable to that of previous reports. CONCLUSION ACRT using cisplating and 5-fluorouracil was well tolerated with acceptable efficacy. LEVEL OF EVIDENCE IVa.
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Affiliation(s)
- Kenzo Ohara
- Asahikawa Medical University, Department of Otolaryngology-Head and Neck Surgery, Asahikawa, Japan.
| | - Miki Takahara
- Asahikawa Medical University, Department of Otolaryngology-Head and Neck Surgery, Asahikawa, Japan
| | - Takumi Kumai
- Asahikawa Medical University, Department of Otolaryngology-Head and Neck Surgery, Asahikawa, Japan; Asahikawa Medical University, Department of Innovative Head & Neck Cancer Research and Treatment (IHNCRT), Asahikawa, Japan
| | - Masaaki Yamashina
- Asahikawa Medical University, Department of Radiology, Asahikawa, Japan
| | - Kan Kishibe
- Asahikawa Medical University, Department of Otolaryngology-Head and Neck Surgery, Asahikawa, Japan
| | - Akihiro Katada
- Asahikawa Medical University, Department of Otolaryngology-Head and Neck Surgery, Asahikawa, Japan
| | - Tatsuya Hayashi
- Asahikawa Medical University, Department of Otolaryngology-Head and Neck Surgery, Asahikawa, Japan
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Phase I trial of concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF-CRT) for locally advanced squamous cell carcinoma of the external auditory canal. Eur Arch Otorhinolaryngol 2021; 279:2805-2810. [PMID: 34263358 DOI: 10.1007/s00405-021-06974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Chemoradiotherapy with docetaxel (DOC), cisplatin (CDDP), and 5-FU (TPF-CRT) for locally advanced external auditory canal cancer (EACC) has favorable oncological and functional outcomes. To establish TPF-CRT as a standard of care for advanced EACC, we conducted this study to determine the maximum tolerated (MTD) and recommended dose (RD) of DOC in TPF-CRT for locally advanced EACC. METHODS To determine the recommended (RD) and maximum tolerated dose (MTD) of DOC in TPF-CRT for EACC, a phase I trial was conducted using the standard "3 + 3" design for maximum dose finding. DOC was administered twice every 4 weeks, CDDP at 70 mg/m2 and 5-FU at 700 mg/m2; patients were also receiving radiotherapy (66 Gy). Eight patients with T3 or T4 EACC were prospectively enrolled. RESULTS Two patients treated with DOC, 50 mg/m2, and one out of six patients treated with DOC, 40 mg/m2, had dose-limiting toxicities. Prolonged febrile neutropenia was observed in three patients. Grade 3 non-hematological toxicities were observed in only three patients. At study completion, six patients survived, five of whom were disease free. CONCLUSION The RD and MTD of DOC in TPF-CRT for locally advanced EACC are 40 mg/m2 when doses of CDDP and 5-FU are 70 mg/m2 and 700 mg/m2, respectively.
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Imoto T, Kondo S, Wakisaka N, Hai PT, Seishima N, Kano M, Ueno T, Mizokami H, Nakanishi Y, Hatano M, Endo K, Sugimoto H, Moriyama-Kita M, Yoshizaki T. Overexpression of Semaphorin 3A is a Marker Associated with Poor Prognosis in Patients with Nasopharyngeal Carcinoma. Microorganisms 2020; 8:microorganisms8030423. [PMID: 32192122 PMCID: PMC7143379 DOI: 10.3390/microorganisms8030423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
Semaphorins were discovered as guidance signals that mediate neural development. Recent studies suggest that semaphorin 3A (Sema3A), a member of the semaphorin family, is involved in the development of several cancers. This study aimed to analyze the association of Sema3A with the clinical features of nasopharyngeal carcinoma (NPC), an Epstein–Barr virus-associated carcinoma, and the Epstein–Barr virus primary oncogene latent membrane protein 1 (LMP1). The expression of Sema3A and LMP1 was immunohistochemically examined in the 35 NPC specimens. The mean expression scores for Sema3A and LMP1 were 20.8% ± 14.5% and 13.9% ± 14.8%, respectively. The expression of Sema3A significantly correlated with that of LMP1 (r = 0.41, p = 0.014). In addition, the Sema3A high cohort showed significantly poorer prognosis than the Sema3A low cohort. Sema3A expression was higher in the LMP1-positive KH-1 and KR-4 cell lines compared to the LMP1-negative HeLa cells. Overexpression of LMP1 in the LMP1-negative AdAH cell line upregulated Sema3A expression, both at the transcriptional and translational level. Finally, Sema3A expression was associated with poor prognosis in patients with NPC. Our data suggest that LMP1 induces the expression of Sema3A, which may promote tumor progression in NPC.
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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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Kawahira M, Yokota T, Hamauchi S, Onozawa Y, Ogawa H, Onoe T, Kamijo T, Iida Y, Nishimura T, Onitsuka T, Yasui H. Survival benefit of adding docetaxel, cisplatin, and 5-fluorouracil induction chemotherapy to concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma with nodal Stage N2-3. Jpn J Clin Oncol 2017; 47:705-712. [PMID: 28431119 DOI: 10.1093/jjco/hyx057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/05/2017] [Indexed: 11/14/2022] Open
Abstract
Background Concurrent chemoradiotherapy followed by adjuvant chemotherapy (CCRT-AC) has been established as the standard of care in locally advanced nasopharyngeal carcinoma (LA-NPC). The survival benefit of induction chemotherapy (ICT) for LA-NPC remains controversial. We analyzed the efficacy and feasibility of docetaxel, cisplatin and 5-fluorouracil (TPF) ICT followed by CCRT for LA-NPC with nodal Stage N2-3. Methods We performed a retrospective analysis of 28 LA-NPC patients with nodal Stage N2-3 receiving induction TPF followed by CCRT (TPF group; n = 12) or CCRT-AC (CCRT group; n = 16) between October 2006 and May 2016. Results The median follow-up periods were 36.4 (range 6.7-55.2) and 40.1 months (range 4.3-99.0) for the TPF and CCRT groups, respectively. One- and three-year overall survival for the TPF group vs. the CCRT group were 100% and 100% vs. 94% and 75%, respectively (P = 0.21). The cumulative one- and three-year incidences of locoregional recurrence or progression for the TPF group vs. the CCRT group were 10% and 21% vs. 16% and 32% (P = 0.49), and those of distant metastasis were 0% and 0% vs. 26% and 26%, respectively (P = 0.08). The common Grade 3-4 acute toxicities were neutropenia, anorexia, febrile neutropenia, and stomatitis in the TPF group. The Grade 3-4 late toxicities did not differ significantly between the two groups. Conclusions This study suggests that induction TPF followed by CCRT might reduce distant metastasis, so this combination may be feasible for the treatment of LA-NPC with nodal Stage N2-3.
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Affiliation(s)
| | | | | | | | | | | | - Tomoyuki Kamijo
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshiyuki Iida
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Tetsuro Onitsuka
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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Nakanishi Y, Wakisaka N, Kondo S, Endo K, Sugimoto H, Hatano M, Ueno T, Ishikawa K, Yoshizaki T. Progression of understanding for the role of Epstein-Barr virus and management of nasopharyngeal carcinoma. Cancer Metastasis Rev 2017; 36:435-447. [PMID: 28819752 PMCID: PMC5613035 DOI: 10.1007/s10555-017-9693-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is very common in southern China and Southeast Asia. In regions where NPC is endemic, undifferentiated subtypes constitute most cases and are invariably associated with Epstein-Barr virus (EBV) infection, whereas the differentiated subtype is more common in other parts of the world. Undifferentiated NPC is a unique malignancy with regard to its epidemiology, etiology, and clinical presentation. Clinically, NPC is highly invasive and metastatic, but sensitive to both chemotherapy and radiotherapy (RT). Overall prognosis has dramatically improved over the past three decades because of advances in management, including the improvement of RT technology, the broader application of chemotherapy, and more accurate disease staging. Despite the excellent local control with modern RT, distant failure remains a challenging problem. Advances in molecular technology have helped to elucidate the molecular pathogenesis of NPC. This article reviews the contribution of EBV gene products to NPC pathogenesis and the current management of NPC.
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Affiliation(s)
- Yosuke Nakanishi
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Naohiro Wakisaka
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Satoru Kondo
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Kazuhira Endo
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Hisashi Sugimoto
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Miyako Hatano
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Takayoshi Ueno
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Kazuya Ishikawa
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan.
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Matsuzuka T, Sato H, Suzuki R, Suzuki M, Saijoh S, Ikeda M, Nakaegawa Y, Tani A, Imaizumi M, Matsui T, Nomoto Y, Nomoto M, Tada Y, Suzuki Y, Omori K. Chemoselection combined with alternating chemoradiotherapy or surgery for hypopharyngeal cancer. Laryngoscope 2015; 126:1349-53. [PMID: 26536058 DOI: 10.1002/lary.25780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/30/2015] [Accepted: 10/14/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS In order to make possible organ preservation, since 2007 our hospital has performed induction chemotherapy (ICT) with cisplatin and 5-fluorouracil (PF) for hypopharyngeal cancer as chemoselection, followed by alternating chemoradiotherapy (ACRT) with docetaxel, cisplatin, and 5-fluorouracil in (TPF) good responders and curative surgery was used in poor responders. METHODS Twenty-six patients with stage III to stage IVB hypopharyngeal cancer received ICT. Eleven of the patients were classified as poor responders and received curative surgery. The remaining 15 patients were classified as good responders. Three of these patients underwent curative surgery, and the remaining 12 underwent ACRT. RESULTS The primary lesions in the 12 ACRT patients responded completely to treatment without severe late toxicities. The estimated 3-year laryngectomy-free rate for all 26 patients was 23%. The estimated 3-year overall survival rates for all 26 patients, 12 patients treated with ACRT, and 14 patients who underwent curative surgery, were 79%, 75%, and 84%, respectively. CONCLUSION The patients who underwent ACRT showed no significant difference in overall survival compared with the patients who underwent curative surgery. All the patients were able to proceed with this series of therapy, indicating that ICT with PF could be a feasible tool for choosing good responders. Because ACRT with TPF had a high response rate and fewer severe toxicities, this treatment could be safe and have enough impact to control hypopharyngeal cancer in good responders. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1349-1353, 2016.
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Affiliation(s)
- Takashi Matsuzuka
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Hisashi Sato
- Department of Radiation Oncology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Ryo Suzuki
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Masahiro Suzuki
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Satoshi Saijoh
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Masakazu Ikeda
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Yuta Nakaegawa
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Akiko Tani
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Takamichi Matsui
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Yukio Nomoto
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Mika Nomoto
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Yasuhiro Tada
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Yoshiyuki Suzuki
- Department of Radiation Oncology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
| | - Koichi Omori
- Department of Otolaryngology, Fukushima Medical University, School of Medicine, Fukushima City, Fukushima, Japan
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Fuwa N, Kodaira T, Daimon T, Yoshizaki T. The long-term outcomes of alternating chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a multiinstitutional phase II study. Cancer Med 2015; 4:1186-95. [PMID: 25991077 PMCID: PMC4559030 DOI: 10.1002/cam4.469] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/01/2015] [Accepted: 03/30/2015] [Indexed: 11/25/2022] Open
Abstract
To examine the long-term outcomes of alternating chemoradiotherapy (ALCRT) for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and to assess the efficacy of ALCRT for NPC. Patients with stage IIB to IVB, ECOG PS 0-2, 18-70 years-old, and sufficient organ function were eligible for this study. First, chemotherapy, consisting of 5-fluorouracil (800 mg/m(2) per 24 h on days 1-5) and cisplatin (100 mg/m(2) per 24 h on day 6), was administered, then a wide field of radiotherapy (36 Gy/20 fraction), chemotherapy, a shrinking field of radiotherapy (34 Gy/17 fraction), and chemotherapy were performed alternately. Between December 2003 and March 2006, 90 patients in 25 facilities were enrolled in this study, 87 patients were finally evaluated. A total of 67 patients (76.1%) completed the course of treatment. The overall survival and the progression-free survival rates at 5 years were 78.04% (95% CI: 69.1~87.0%), and 68.74% (95% CI: 58.8~78.7%), respectively. The long-term outcomes of ALCRT for NPC were thought to be promising. ALCRT will be considered to be a controlled trial to compare therapeutic results with those of concurrent chemoradiotherapy for NPC.
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Affiliation(s)
- Nobukazu Fuwa
- Department of Radiology, Hyogo Ion Beam Medical CenterHyogo, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer CenterAichi, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of MedicineHyogo, Japan
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Miyaushiro S, Kitanaka A, Kubuki Y, Hidaka T, Shide K, Kameda T, Sekine M, Kamiunten A, Umekita Y, Kawabata T, Ishiguro Y, Shimoda K. Nasopharyngeal carcinoma with bone marrow metastasis: positive response to weekly paclitaxel chemotherapy. Intern Med 2015; 54:1455-9. [PMID: 26028007 DOI: 10.2169/internalmedicine.54.3917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 51-year-old man with nasopharyngeal carcinoma underwent chemoradiotherapy with cisplatin and 5-fluorouracil, followed by a left cervical lymphadenectomy. Distant metastatic disease was excluded using fluoro-deoxyglucose positron emission tomography. Seven months later, bone marrow metastasis and disseminated intravascular coagulation were diagnosed. The patient received weekly paclitaxel therapy and maintained a good performance status for seven months. During the treatment period, the patient developed no severe organ toxicity except for neutropenia. Weekly paclitaxel may therefore be considered as the treatment of choice in patients with advanced or recurrent nasopharyngeal carcinoma with bone marrow metastasis.
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Affiliation(s)
- Sae Miyaushiro
- Clinical Training Center after Graduation, University of Miyazaki Hospital, Japan
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Ueno T, Endo K, Kondo S, Wakisaka N, Murono S, Ito M, Yoshizaki T. Factors Affecting Outcomes of Alternating Chemoradiotherapy for Nasopharyngeal Cancer. Ann Otol Rhinol Laryngol 2014; 123:509-16. [DOI: 10.1177/0003489414525122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Nasopharyngeal cancer (NPC) is radiosensitive and chemosensitive. We evaluated the efficacy of alternating chemoradiotherapy in patients with advanced NPC. Methods: Alternating chemoradiotherapy was initiated in 30 patients with NPC, and 27 patients with cancer stages II (n = 6), III (n = 8), IVA (n = 9), and IVB (n = 4) were retrospectively analyzed. Chemotherapy was initially administered followed by radiotherapy, and chemotherapy, radiotherapy, and chemotherapy were alternately administered. Of the 27 patients, 22 patients received cisplatin (50 mg/m2/day, days 6 and 7) and 5-fluorouracil (5-FU; 800 mg/m2/day, days 1-5), whereas 5 patients received carboplatin (AUC 4-5, day 6) and 5-FU. Results: Of the 27 patients, 19 (70%) received 3 chemotherapy courses. The total duration of alternating chemoradiotherapy was 81 to 101 days (median, 90 days). At a median follow-up of 53 months, the 5-year progression-free survival (PFS) was 71%. Multivariate analysis showed that weight loss and the number of chemotherapy courses had a significant effect on PFS. Conclusion: Alternating chemoradiotherapy led to similar or higher survival rates compared with concurrent chemoradiotherapy, which was characterized by good compliance and adaptable intensity.
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Affiliation(s)
- Takayoshi Ueno
- Division of Otolaryngology–Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Kazuhira Endo
- Division of Otolaryngology–Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Satoru Kondo
- Division of Otolaryngology–Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Naohiro Wakisaka
- Division of Otolaryngology–Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Shigeyuki Murono
- Division of Otolaryngology–Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Makoto Ito
- Division of Otolaryngology–Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology–Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Expression of seven-in-absentia homologue 1 and hypoxia-inducible factor 1 alpha: novel prognostic factors of nasopharyngeal carcinoma. Cancer Lett 2012; 331:52-7. [PMID: 23228635 DOI: 10.1016/j.canlet.2012.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/12/2012] [Accepted: 12/01/2012] [Indexed: 11/20/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is an EBV-associated cancer. We analysed Siah1 expression as well as LMP1 and HIF1α expression by immuno-histochemical staining in 74 NPC biopsy specimens and found that the expression of Siah1 was significantly correlated with advanced tumour status and stage. Moreover, Siah1-positive and HIF1α-positive cases had significantly worse prognoses. The expression score for LMP1 was remarkably correlated with that of Siah1, whereas there was little correlation between LMP1 expression and the other markers evaluated. This is the first study to evaluate the pattern and clinical significance of Siah1 and HIF1α expression in NPC, and such an evaluation is valuable for identifying those patients at a high risk for a poor prognosis.
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Nakahara R, Kodaira T, Furutani K, Tachibana H, Tomita N, Inokuchi H, Mizoguchi N, Goto Y, Ito Y, Naganawa S. Treatment outcomes of definitive chemoradiotherapy for patients with hypopharyngeal cancer. JOURNAL OF RADIATION RESEARCH 2012; 53:906-915. [PMID: 22843377 PMCID: PMC3483853 DOI: 10.1093/jrr/rrs052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/28/2012] [Accepted: 06/13/2012] [Indexed: 06/01/2023]
Abstract
We analyzed the efficacy of definitive chemoradiotherapy (CRT) for patients with hypopharyngeal cancer (HPC). Subjects comprised 97 patients who were treated with definitive CRT from 1990 to 2006. Sixty-one patients (62.9%) with resectable disease who aimed to preserve the larynx received induction chemotherapy (ICT), whereas 36 patients (37.1%) with resectable disease who refused an operation or who had unresectable disease received primary alternating CRT or concurrent CRT (non-ICT). The median dose to the primary lesion was 66 Gy. The median follow-up time was 77 months. The 5-year rates of overall survival (OS), progression-free survival (PFS), local control (LC), and laryngeal preservation were 68.7%, 57.5%, 79.1%, and 70.3%, respectively. The T-stage was a significant prognostic factor in terms of OS, PFS and LC in both univariate and multivariate analyses. The 5-year rates of PFS were 45.4% for the ICT group and 81.9% for the non-ICT group. The difference between these groups was significant with univariate analysis (P = 0.006). Acute toxicity of Grade 3 to 4 was observed in 34 patients (35.1%). Grade 3 dysphagia occurred in 20 patients (20.6%). Twenty-nine (29.8%) of 44 patients with second primary cancer had esophageal cancer. Seventeen of 29 patients had manageable superficial esophageal cancer. The clinical efficacy of definitive CRT for HPC is thought to be promising in terms of not only organ preservation but also disease control. Second primary cancer may have a clinical impact on the outcome for HPC patients, and special care should be taken when screening at follow-up.
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Affiliation(s)
- Rie Nakahara
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi, Japan.
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Fujii R, Imanishi Y, Tomita T, Sakamoto K, Shigetomi S, Habu N, Ootsuka K, Sato Y, Ozawa H, Yamashita T, Fujii M, Shigematsu N, Ogawa K. [Statistical analysis of 32 patients with nasopharyngeal carcinoma]. NIHON JIBIINKOKA GAKKAI KAIHO 2012; 115:773-782. [PMID: 23016269 DOI: 10.3950/jibiinkoka.115.773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED In order to assess the clinical outcome and prognostic factors of patients with nasopharyngeal carcinoma (NPC) who were initially treated in the Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine between 1997 and 2006, statistical analyses were performed based on the patient medical records. Cause-specific survival (CSS) and disease-free survival (DFS) in all cases (stage I to IV, n = 32) and advanced cases (stage III and IV, n = 22) were estimated using the Kaplan-Meier method. The independent prognostic values of the clinical and therapeutic factors were determined using multivariate Cox proportional hazards models. RESULTS The 5-year CSS/DFS were 43.4%/34.8% in all cases and 34.5%/29.8% in advanced cases. Multivariate analysis revealed that, in all cases, the independent prognostic factors for CSS were age (> or = 61 vs. < or = 60, risk ratio (RR) = 5.717, p = 0.006), T-stage (3/4 vs. 1/2, RR = 6.957, p = 0.004), and the use of platinum agents (unused vs. used, RR = 3.911, p = 0.012), whereas those for DFS were T-stage (3/4 vs. 1/2, RR = 3.499, p = 0.019) and the use of platinum agents (unused vs. used, RR = 2.947, p = 0.028). In advanced cases, the use of platinum agents alone was significant for both CSS (RR = 4.503, p = 0.023) and DFS (RR = 4.218, p = 0.014). The patients who received neoadjuvant chemotherapy (NAC) showed better CSS and DFS than the patients who did not (p = 0.066 and p = 0.025, respectively) in a univariate analysis (Log-rank test), although no significant difference was seen between these groups in the multivariate analysis. CONCLUSION The advantage of the administration of platinum agents in the treatment of NPC was statistically corroborated even in our study with its small sample size. As agents combined with chemoradiotherapy, the efficacy of docetaxel alone did not seem comparable to that of platinum agents. The docetaxel-CDDP-5-FU regimen applied as NAC was suggested to be possibly beneficial for advanced cases of NPC.
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Affiliation(s)
- Ryoichi Fujii
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine
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Yoshizaki T, Ito M, Murono S, Wakisaka N, Kondo S, Endo K. Current understanding and management of nasopharyngeal carcinoma. Auris Nasus Larynx 2011; 39:137-44. [PMID: 21592702 DOI: 10.1016/j.anl.2011.02.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 11/19/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is a kind of rare head and neck cancer in Japan. However, NPC has some unique features. It is one of the most popular cancers in southern China, Southeast Asia, the Arctic, and the middle East/north Africa. This distinctive racial, ethnical, and geographic predisposition to NPC implies that both genetic susceptibility and environmental factors contribute to the development of this tumor. NPC is an Epstein-Barr virus - associated tumor. Consistent elevation of EBV antibody titers is a well-established risk factor of development of NPC. Not only pathophysiological relationship, but also molecular mechanism of EBV-mediated carcinogenesis has been enthusiastically investigated. LMP1, an EBV primary oncogene, upregulates each step of metastasis, and contribute to highly metastatic feature of NPC. A tumor suppressor gene p53 is mostly intact and overexpressed in NPC whereas expression of p16, a cyclin-dependent kinase inhibitory protein, is downregulated in 2/3 of NPC. Intention modulated radiotherapy (IMRT) is now getting prevalent for the treatment of NPC because of complicated structure and location of nasopharynx. A good therapeutic result can be achieved by distributing a high dose to the tumor while keeping down normal tissue complications by reducing radiation dose to normal tissues. Chemotherapy is important to control distant metastasis of chemoradiosensitive NPC, and thus, should play an important role. However, most effective combination of anti-tumor drugs, protocol of chemoradiotherapy has not well-established. Finally, molecular targeting therapy, including targeting EBV gene product, has been developing and on the way to the clinical use.
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Affiliation(s)
- Tomokazu Yoshizaki
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan.
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Concurrent chemoradiation followed by adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma in Korea. Cancer Chemother Pharmacol 2009; 66:643-51. [PMID: 20033411 DOI: 10.1007/s00280-009-1203-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 11/27/2009] [Indexed: 01/30/2023]
Abstract
PURPOSE Concomitant approach using cisplatin and 5-fluorouracil (5-FU) has shown an excellent local control rate and significantly reduced distant metastasis in patients with locally advanced nasopharyngeal carcinoma (NPC). However, optimal schedule and dosing of chemotherapy still need to be developed to reduce distant metastasis. This retrospective study was conducted to evaluate the efficacy, toxicity, and tolerability of a concurrent chemoradiation therapy (CCRT) regimen using cisplatin and 5-FU followed by adjuvant chemotherapy (AC) in patients with locoregionally advanced NPC. METHODS Forty-three NPC patients who had AJCC stage T3/T4 or N2/N3 and M0 disease were evaluated. The chemotherapy during CCRT consisted of cisplatin (75 mg/m(2) on day 1) plus 5-FU (750 mg/m(2)/day on day 1-5), delivered every 4 weeks for two cycles. Three cycles of AC were given with cisplatin (75 mg/m(2)), epirubicin (37.5 mg/m(2)) on day 1, and bleomycin (7.5 mg/m(2) bolus iv. on day 1 followed by 9 mg/m(2) on day 1-5 by continuous infusion) every 3 weeks. RESULTS The overall response rate after CCRT was 95% (22 CRs and 19 PRs in 43) and 100% (16 CRs and 8 PRs in 24) after AC. Grade 3/4 neutropenia, mucositis, and weight loss were observed during CCRT phase in 18, 44, and 26% of patients, respectively. AC caused grade 3/4 neutropenia and emesis in 12.5 and 20.8% of patients, respectively. CONCLUSIONS CCRT regimen using cisplatin and 5-FU followed by three cycles of BEC chemotherapy was effective in locally advanced NPC patients, with acceptable and reversible acute toxicities.
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Long-term follow-up and a detailed prognostic analysis of patients with oropharyngeal cancer treated with radiotherapy. J Cancer Res Clin Oncol 2009; 136:617-23. [PMID: 19859735 DOI: 10.1007/s00432-009-0700-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 10/09/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To find a prognostic factor for patients with oropharyngeal cancer (OPC) who were followed for long term after definitive radiotherapy. METHODS OPC patients that had been treated with radiotherapy at our institution were reviewed. Sex, age, performance status (PS), subsite, disease stage, T-stage, N-stage, RT dose, concurrent chemotherapy, the duration of RT, hemoglobin concentration before any treatment, and a double cancer were assessed for their impact on overall survival (OS) and locoregional control (LRC). RESULTS Among a total of 141 patients enrolled into this retrospective study, the disease of most patients (81%) was stage III or IV. The median follow-up time of the surviving patients was 56 months (range 5-175 months). Radiotherapy was administered in conventional fractionation, and the median RT dose was 66 Gy. Most patients (90%) received systemic chemotherapy. The 5-year estimates of progression-free survival, LRC, and OS were 66.0, 72.7, and 65.1%, respectively. In the univariate analysis, LRC and OS in the lateral wall at the primary site, T-stage <or=3, and PS <or=1 groups were significantly superior to those in the other groups, and OS in age <or=60 or the hemoglobin level >13.0 g/dL groups were also significantly superior to those in the other groups. In the multivariate analysis, age and T-stage remained significant factors for OS. CONCLUSIONS Primary radiotherapy was recommended for OPC patients with the lateral wall at the primary site because of good LRC. The treatment method to the older population and T4 tumor is future tasks.
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Prospective Study of Alternating Chemoradiotherapy Consisting of Extended-Field Dynamic Conformational Radiotherapy and Systemic Chemotherapy Using 5-FU and Nedaplatin for Patients in High-Risk Group With Cervical Carcinoma. Int J Radiat Oncol Biol Phys 2009; 73:251-8. [DOI: 10.1016/j.ijrobp.2008.03.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/12/2008] [Accepted: 03/27/2008] [Indexed: 11/19/2022]
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